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{{DiseaseDisorder infobox |
__NOTOC__
  Name        = Status asthmaticus|
{{status asthmaticus}}
  ICD10      = {{ICD10|J|46||j|40}} |
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
  ICD9        = {{ICD9|493.01}}, {{ICD9|493.91}} |
 
}}
{{Asthma}}
{{CMG}}; {{AOEIC}} {{LG}}
{{CMG}}; {{AOEIC}} {{LG}}


==Overview==
==[[Status asthmaticus overview|Overview]]==
'''Status asthmaticus''' is an [[Acute (medical)|acute]] exacerbation of [[asthma]] that does not respond to standard [[Bronchodilator|bronchodilator]] and [[corticosteroid]] therapy. Symptoms include [[chest tightness]], [[dyspnea|rapidly progressive dyspnea]], [[cough|non-productive cough]] and [[Wheeze|wheezing]]. Status asthmaticus if left untreated may result in severe [[bronchospasm]], mucus plugging and rapidly develops [[acidosis]] and [[respiratory failure]] as a consequent of [[carbon di oxide]] retention and [[hypoxemia]].
 
==[[Status asthmaticus pathophysiology|Pathophysiology]]==
 
==[[Status asthmaticus causes|Causes]]==
 
==[[Status asthmaticus differential diagnosis|Differentiating Status Asthmaticus from other Diseases]]==
 
==[[Status asthmaticus epidemiology and demographics|Epidemiology and Demographics]]==


==Epidemiology==
==[[Status asthmaticus risk factors|Risk Factors]]==
Approximately 10% of the US population is affected by asthma with status asthmaticus requiring highest rates of hospitalization.<ref name="pmid18955910">Gorelick M, Scribano PV, Stevens MW, Schultz T, Shults J (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18955910 Predicting need for hospitalization in acute pediatric asthma.] ''Pediatr Emerg Care'' 24 (11):735-44. [http://dx.doi.org/10.1097/PEC.0b013e31818c268f DOI:10.1097/PEC.0b013e31818c268f] PMID: [http://pubmed.gov/18955910 18955910]</ref>


==Predisposing factors==
==[[Status asthmaticus natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
*Increase use of [[bronchodilator]] despite resistance,
*Frequent exacerbations despite the use of [[corticosteroids]],
*Despite adhering to therapy, a peak flow rate of less than 10% from baseline,
*Frequent hospitalization for acute attacks,
*History of [[syncope]] or [[seizure]] during an acute asthmatic attack,
*Oxygen saturation lower than 92% despite supplemental oxygen,
*Airway obstruction is significantly reduced, resulting in severe impairment of air motion that leads to a '''silent chest''' with the absence of [[wheeze]] suggestive of an [[respiratory failure|imminent respiratory arrest]].


==Diagnosis==
==Diagnosis==
===History and Symptoms===
*[[dyspnea|Rapidly progressive dyspnea]]
*[[cough|Non-productive cough]]
*[[sweating|Profuse sweating]]
*[[Cyanosis]]
*[[Loss of consciousness]] and/or [[seizure]] secondary to [[hypoxia|severe hypoxia]] may be observed
*Inability to speak more than one or two words may be observed with severe airway obstruction


===Physical Examination===
[[Status asthmaticus history and symptoms|History and Symptoms]] | [[Status asthmaticus physical examination|Physical Examination]] | [[Status asthmaticus laboratory findings|Laboratory Findings]] | [[Status asthmaticus electrocardiogram|Electrocardiogram]] | [[Status asthmaticus chest x ray|Chest X ray]] | [[Status asthmaticus CT|CT]] | [[Status asthmaticus MRI|MRI]] | [[Status asthmaticus other imaging findings|Other Imaging Findings]] | [[Status asthmaticus other diagnostic studies|Other Diagnostic Studies]]
====Vital Signs====
 
*Early stages:
==Treatment==
:*[[Tachypnea|Increased respiratory rate]] greater than 30 cycles per minute
:*[[Tachycardia|Increased heart rate]]
:*[[Pulsus paradoxus]] (a fall of SBP greater than 20-40 mmHg during inspiration)


*With progressive untreated airway obstruction, increased work of breathing may result in [[bradycardia]], [[hypoventilation]] and [[cardiorespiratory arrest]]
[[Status asthmaticus medical therapy|Medical Therapy]] | [[Status asthmaticus primary prevention|Primary Prevention]] | [[Status asthmaticus secondary prevention|Secondary Prevention]] | [[Status asthmaticus cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Status asthmaticus future or investigational therapies|Future or Investigational Therapies]]
====General Physical Examination====
*Sit upright with arms extended to support the upper chest ('''tripod position''') that assist the use of accessory muscles of respiration
*Use of accessory muscles of respiration


==References==
==Case Studies==
{{reflist|2}}
[[Status asthmaticus case study one|Case #1]]


[[Category:Asthma]]
[[Category:Asthma]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]

Latest revision as of 20:18, 30 January 2013

Status Asthmaticus Microchapters

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Overview

Pathophysiology

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Differentiating Status Asthmaticus from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Pathophysiology

Causes

Differentiating Status Asthmaticus from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X ray | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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