Asthma exacerbation resident survival guide: Difference between revisions
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{{Family tree | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01='''Initial assessment'''<br>H&P<br>O2 sat<br>Spirometry<br>'''Initial management'''<br>O2<br>SABA}} | {{Family tree | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01='''Initial assessment'''<br>H&P<br>O2 sat<br>Spirometry<br>'''Initial management'''<br>O2<br>SABA}} | ||
{{Family tree | | | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|.| | | | | | | | | | |}} | {{Family tree | | | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|.| | | | | | | | | | |}} | ||
{{Family tree | | | | | C01 | | | | | | C02 | | | C03 | | | | | | | | | |}} | {{Family tree | | | | | C01 | | | | | | C02 | | | C03 | | | | | | | | | |C01='''Moderate exacerbation'''<br>FEV1PEF40-60%<br>dyspnea with<br> daily activities|C02='''Severe exacerbation'''<br>FEV1/PEF<40%<br>Dyspnea at rest |C03='''Respiratory arrest'''<br> Intubation & mechanical ventilation<br>100%O2<br>SABA & Ipratropium<br>IV corticosteroids }} | ||
{{Family tree | | | | | |!| | | | | | | |!| | | | |!| | | | | | | | | | |}} | {{Family tree | | | | | |!| | | | | | | |!| | | | |!| | | | | | | | | | |}} | ||
{{Family tree | | | | | D01 | | | | | | D02 | | | |!| | | | | | | | | | |}} | {{Family tree | | | | | D01 | | | | | | D02 | | | |!| | | | | | | | | | |D01=O2(target>90%sat)<br>Inhaled SABA every 60mins<br>PO corticosteroids|D02=O2(>90%sat)<br>SABA+Ipratropium continuous<br>PO corticosteroids<br>consider adjuncent therapy }} | ||
{{Family tree | | | | | |`|-|-|-|v|-|-|-|'| | | | |!| | | | | | | | | | |}} | {{Family tree | | | | | |`|-|-|-|v|-|-|-|'| | | | |!| | | | | | | | | | |}} | ||
{{Family tree | | | | | |,|-|-|-|+|-|-|-|.| | | | |!| | | | | | | | | | |}} | {{Family tree | | | | | |,|-|-|-|+|-|-|-|.| | | | |!| | | | | | | | | | |}} | ||
{{Family tree | | | | | E01 | | E02 | | E03 | | | |!| | | | | | | | | | |}} | {{Family tree | | | | | E01 | | E02 | | E03 | | | |!| | | | | | | | | | |E01=Good response<br>FEV1/PEF>70%<br>No distress<br>Stable after 60 mins of Rx<br>Normal H&P|E02=Incomplete response<br>FEV1?PEF40-60%<br>Mild-mod symptoms|E03=Poor response<br>FEV1/PEF<40%<br>PCO2≥42 mm Hg<br>Confusion and severe symptoms}} | ||
{{Family tree | | | | | |!| | | |!| | | |!| | | | |!| | | | | | | | | | |}} | {{Family tree | | | | | |!| | | |!| | | |!| | | | |!| | | | | | | | | | |}} | ||
{{Family tree | | | | | F01 | | F02 | | F03 |-|-|-|'| | | | | | | | | | |}} | {{Family tree | | | | | F01 | | F02 | | F03 |-|-|-|'| | | | | | | | | | |F01=Discharge|F02=Admit to ward|F03=Admit to ICU }} | ||
{{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{Family tree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{Family tree | | | | | | | | | | | | | G03 | | | | | | | | | | | | | | |}} | {{Family tree | | | | | | | | | | | | | G03 | | | | | | | | | | | | | | |G03=Intubation<br>&ventilation<br>IV Corticosteroids<br>SABA}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 17:55, 3 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
Causes
Life threatening causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated
common causes
Management
| Dyspnea Cough Wheezing Chest tightness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Initial assessment H&P O2 sat Spirometry Initial management O2 SABA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Moderate exacerbation FEV1PEF40-60% dyspnea with daily activities | Severe exacerbation FEV1/PEF<40% Dyspnea at rest | Respiratory arrest Intubation & mechanical ventilation 100%O2 SABA & Ipratropium IV corticosteroids | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| O2(target>90%sat) Inhaled SABA every 60mins PO corticosteroids | O2(>90%sat) SABA+Ipratropium continuous PO corticosteroids consider adjuncent therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Good response FEV1/PEF>70% No distress Stable after 60 mins of Rx Normal H&P | Incomplete response FEV1?PEF40-60% Mild-mod symptoms | Poor response FEV1/PEF<40% PCO2≥42 mm Hg Confusion and severe symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Discharge | Admit to ward | Admit to ICU | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intubation &ventilation IV Corticosteroids SABA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||