the crashing asthmatic

EmergencyMedicineIreland.com

The Crashing Asthmatic


The Basics

Beta2 agonists +++


Non-response to salbutamol

Genetics vs Tachyphylaxis


Why IV?


Magnesium

2009•7 Studies (5 Adult; 2 Kids)•665 pts

EmergencyMedicineIreland.comcredit: http://www.freeimageslive.co.uk/

http://www.freeimageslive.co.uk

http://www.freeimageslive.co.uk


Aminophylline2012•15 Studies•817 pts


2012•3 Studies•100 pts

IV Salbutamol


IV Salbutamol

PMID: 16548805


Now entering an evidence free zone...


Adrenaline

Neb/IM/SC/IV


2012•5 Studies •206 pts

Non-Invasive Ventilation

↑FRC↓WOB


When to intubate?

Wait till you would normally intubate someone...

Wait some more...

But not too long...


Intubation

Ketamine•bronchodilator

•pre and for induction•? problems with secretions

Lignocaine•IV and inhaled

•reduced airway responsiveness


Difficult Ventilation

Credit: http://emcrit.org/podcasts/severe-asthmatic/

http://emcrit.org/podcasts/severe-asthmatic/

http://emcrit.org/podcasts/severe-asthmatic/


Ventilation

Low PEEPAdequate flow ratesReally, really big I:E ratios

Deterioration?•disconnect the vent•squeeze the chest•pleural decompression•fluid loading


Role for ECMO?


thanks for watching

the crashing asthmatic

Healthcare

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