RESUSCITATION TECHNIQUES IN ASTHMA

B Y

A N U G O M E M E K A M B B C H , M P H , M S C O C C M E D , I G C N E B O S H

WELCOME & INTRODUCTIONS

Logistics Emergency exits Restrooms

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AGENDA

Introduction

Epidemiology

Complications of Asthma

Management of Cardiac arrest in Asthma

Definitive Treatment for Asthma

Conclusion

References

Q&A

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INTRODUCTION

Various difficult situations may arise that lead to cardiac arrest.

The skill of bystanders is paramount for outcome of survival.[1]

Resuscitation will need to be modified in these situations depending on their peculiarities and reversible causes.

Early recognition and proper management of Airway Breathing Circulation Disability and Exposure (ABCDE) is very important for survival.[2]

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INTRODUCTION

This presentation is a review based on 2010 Guidelines by American Heart Association and European Resuscitation Council.

Prior Knowledge of current BLS/ACLS guidelines or resuscitation is assumed.

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EPIDEMIOLOGY

Globally over 300million people have asthma[3,4]

. Asthma accounts for 1% of

morbidity burden worldwide. [3,4]

There is an annual mortality rate of 250,000, with a prevalence of 1-18% in Europe.

[3,4]

It is responsible for 2million Emergency room visits in the United states annually.[3,4]

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COMPLICATIONS OF ASTHMA

ASPHYXIA

This is the leading cause of death here and may arise from the following[3,4]:

- severe bronchoconstriction

- mucus plugging.

The absence of wheeze may imply severe airway obstruction.[3,4]

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COMPLICATIONS OF ASTHMA

CARDIAC ARREST

This is rare and may arise after the following.[3,4]

- prolonged hypoxaemia,

- electrolyte imbalance

- drug side effects[3,4]

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COMPLICATIONS OF ASTHMA

Other complications are:

BILATERAL TENSION PNEUMOTHORAX [3,4]

PNEUMONIA [3,4]

ATELECTASIS [3,4]

PULMONARY EDEMA [3,4]

These can lead to death in this condition.[3,4]

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MANAGEMENT OF CARDIAC ARREST IN ASTHMA

In the event of a cardiac arrest arising from asthma, normal BLS and ACLS guidelines are to be followed.[2,3,4]

There is need however for

- Early endotracheal intubation

- Mechanical ventilation, with waveform capnography to ensure and monitor proper tube insertion

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MANAGEMENT OF CARDIAC ARREST IN ASTHMA

-Oxygen should be given at :

- A high flow rate

- But at reduced respiratory rate

with shorter inspiration and longer expiration delivery rate of 1:4 or 1:5 unlike in non-asthmatics.[2,3,4]

Pleural ultrasound scan(preferable) or

Chest X-ray

can be used to rule out tension pneumothorax.[3,4]

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DEFINITIVE TREATMENT FOR ASTHMA The definitive treatments of value to the patient care

consists of the following:

Bronchodilators (β2 Agonists short acting) inhaled or IV[3,4]

IV Corticosteroids[3,4]

Anticholinergics (Ipratropium bromide) inhaled or IV[3,4]

Epinephrine Subcut or IM [3,4]

Leukotriene receptor Antagonists[3,4]

Magnesium sulfate inhaled or IV [3,4]

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DEFINITIVE TREATMENT FOR ASTHMA

However use of Methylxanthines:

e.g. Aminophylline are NO longer recommended in the management, due to their side effects and a lack of strong evidence of its benefits.[3,4]

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CONCLUSION

Difficult situations may arise or lead to need for resuscitation.

Modifications and consideration of reversible factors, including importance of making early decisions to

- initiate resuscitation

- invite expert and

- manage the patient accordingly

is paramount to survival in these situations.

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CONCLUSION

Mastery and awareness of the basic techniques and guidelines for BLS/ACLS by everyone is crucial to success in resuscitation in theses situations.

Get Trained to save lives.

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REFERENCES

1. J.R Casal Codesido, y M.J. Vazquez Lima, 2007; Out-of Hospital Cardiopulmonary Resuscitation: Where are We now? Emergencias 2007;19:295-297.

2. Australian Resuscitation Council; New Zealand Resuscitation Council, 2011; Guideline 11.10 Resuscitation in Special Circumstances: 1-14

3. Jasmeet Soar et al,2010, European Resuscitation Council Guidelines for 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma,anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution; Elsevier Ireland Ltd, Resuscitation 81(2010)1400-1433, doi:10.1016/j.resuscitation.2010.08.015

4. Terry L. Vanden Hoek et al, 2010, Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Circulation.2010:122:S829-S861; doi:10.1161/CIRCULATIONAHA.110.971069; Online ISSN:1524-4539

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QUESTIONS

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