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  • Acute Asthma Update APICON

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    Heemanshu lodhi
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    Acute severe asthma, also known as an asthma exacerbation, is a condition characterized by progressively worsening bronchospasm unresponsive to standard therapy. Signs include tachycardia, tachypnea, use of accessory muscles, inability to speak in full sentences or lie flat, hypoxia with hypocapnia, expiratory wheeze or silent chest, and altered mental status. Treatment involves inhaled beta-2 agonists, systemic steroids, magnesium sulfate, heliox, mechanical ventilation if needed, and prevention through patient education, pharmacotherapy, prevention of triggers, and peak flow monitoring.

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    Acute severe asthma, also known as an asthma exacerbation, is a condition characterized by progressively worsening bronchospasm unresponsive to standard therapy. Signs include tachycardia, tachypnea, use of accessory muscles, inability to speak in full sentences or lie flat, hypoxia with hypocapnia, expiratory wheeze or silent chest, and altered mental status. Treatment involves inhaled beta-2 agonists, systemic steroids, magnesium sulfate, heliox, mechanical ventilation if needed, and prevention through patient education, pharmacotherapy, prevention of triggers, and peak flow monitoring.

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    © All Rights Reserved
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    6 views11 pages

    Acute Asthma Update APICON

    Uploaded by

    Heemanshu lodhi
    Acute severe asthma, also known as an asthma exacerbation, is a condition characterized by progressively worsening bronchospasm unresponsive to standard therapy. Signs include tachycardia, tachypnea, use of accessory muscles, inability to speak in full sentences or lie flat, hypoxia with hypocapnia, expiratory wheeze or silent chest, and altered mental status. Treatment involves inhaled beta-2 agonists, systemic steroids, magnesium sulfate, heliox, mechanical ventilation if needed, and prevention through patient education, pharmacotherapy, prevention of triggers, and peak flow monitoring.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 11

    DEFINITION

    A condition of progressively worsening


    bronchospasm unresponsive to standard
    therapy.
    S IGNS

    Tachycardia
    Tachypnea
    Use of accessory muscles.inability to speak
    full sentences,inability to lie flat
    Peak expiratory flow rate measurement
    Hypoxia with hypocapnia(hyp ercapnia
    1

    usually means imminent respi ratory arrest)


    1

    Expiratory wheeze or silent chest


    Altered mental status
    DIFFERENTIAL DIAGNOSIS

    Vocal cord dysfunction


    :_,
    I•
    I
    I
    Upper ai ay obstruction- epiglotitis , foreig1n
    body
    Bronchiectasis
    Pulmonary embolism
    Heart failure
    BETA2 AGONISTS

    /nha/ed(nebulisaton albuterol 2.5 mg every


    20minutes-Faster action,better tolerated

    Parentera/-terbutalin 0 .25 mg SQ or
    epinephrine(1 :1000) 0.3 mg SQ repeat
    every 20 mins for 3 dose,epinephrine
    infusion 1-10mcg/min
    SYSTEMIC STEROIDS

    Oral versus parenteral-oral


    faster(prednisone 1 mg/kg)
    Hydrocortisone versus methylprednisone-
    hydrocortisone less potent,200-500mg
    dosing required,
    Dexamethasone or betamethasone -not
    preferred due to slower onset
    MAGNESIUM SULPHATE

    1 0-20gm il V infusion over 60minutes once n


    1

    the emergency department


    HELIOX

    Helium 70°/o,oxygen 30°/o


    Nonlaminarflow-reduces resistance
    <- o • ftl\UW nr •.c

    MECHANICAL VENTILAT □ ON

    INVASIVE VERSUS NONINVASIVE-


    Intubate if altered sensorium identified,
    noninvasive not usually effective
    Low respiratory rates
    Maintain low peak ai ay pressure
    AutoPEEP -prevent and control
    Sedation-ketamine preferred by soe
    Paralyti~-best to avoid
    TOile 4 P ' s cf PREVENTmON

    Patient education

    Pharmacotherapy

    Prevention of triggers

    Peak flow monitoring


    PREVENTION

    ASTHMA ACTION PLAN


    ASTHMA ACTION PLAN
    what lo look out for - ~

    .
    - -

    --
    ·------ - -

    ,_ D!!!!!II _ _
    - -

    -----
    ..._ _ _ _

    ~-- ____
    1

    ·- ----------
    ·-------
    I

    ___
    ---------~- --- D1AL am, P'01II

    ·-·---.--.---
    ------~-----·
    ~ ._.._.

    I
    ANIJUI.ASICl:I

    ------·-
    - ----,_.~~--
    -..
    --
    ·--- ~ ~ '-,
    I
    O:OB:15
    CO• • AIJSI IU!i l 1

    1Death 6.7% 11.1% 0,.08


    Cardiovascular death 3.3% 8.3% 0.01
    ,Myocardial infarction 7.7% 12.8% 0.06
    1Stroke 1.8% 3.4% 0.24
    ilschemia-driven.LM complex TLR 7.2% 15.7% 0.003
    ,lschemia-driven,revascularizaition (all) 12.0% 16.1% 0.18
    .Stent thrombosis (detinite/proba.ble) 1.5% 3.3% 0.15
    1

    .
    tDeath, MI ,or stroke (primary endpoint) 14.0%
    u--..
    20.8% 0.04
    !Death, Ml, strok~, or,ilDR 17~2~ · -·· ;....·-~~--·-
    29.1% 0~01_____,
    --

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