the crashing asthmatic
Post on 23-Aug-2014
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EmergencyMedicineIreland.com
The Crashing Asthmatic
EmergencyMedicineIreland.com
The Basics
Beta2 agonists +++
EmergencyMedicineIreland.com
Non-response to salbutamol
Genetics vs Tachyphylaxis
EmergencyMedicineIreland.com
Why IV?
EmergencyMedicineIreland.com
Magnesium
2009•7 Studies (5 Adult; 2 Kids)•665 pts
EmergencyMedicineIreland.comcredit: http://www.freeimageslive.co.uk/
EmergencyMedicineIreland.com
Aminophylline2012•15 Studies•817 pts
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2012•3 Studies•100 pts
IV Salbutamol
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IV Salbutamol
PMID: 16548805
EmergencyMedicineIreland.com
Now entering an evidence free zone...
EmergencyMedicineIreland.com
Adrenaline
Neb/IM/SC/IV
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2012•5 Studies •206 pts
Non-Invasive Ventilation
↑FRC↓WOB
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When to intubate?
Wait till you would normally intubate someone...
Wait some more...
But not too long...
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Intubation
Ketamine•bronchodilator
•pre and for induction•? problems with secretions
Lignocaine•IV and inhaled
•reduced airway responsiveness
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Difficult Ventilation
Credit: http://emcrit.org/podcasts/severe-asthmatic/
EmergencyMedicineIreland.com
Ventilation
Low PEEPAdequate flow ratesReally, really big I:E ratios
Deterioration?•disconnect the vent•squeeze the chest•pleural decompression•fluid loading
EmergencyMedicineIreland.com
Role for ECMO?
EmergencyMedicineIreland.com
thanks for watching
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