▪️︎Imp: Asthma exacerbation
▪️︎Cond: Emergency
▪️︎Diet: temporary NPO
▪️︎Act: CBR- bed sides up
▪️︎Pos: semi sitting
▪️︎CVS
▪️︎IV line fix
* give IV boluses of isotonic saline if patient is dehydrated due to reduced intake and prolonged episode
▪️︎CM and POM
▪️︎Oxygen therapy with nasal cannula 4L/min or mask 6-10L/min based on the condition if sat<90
* to maintain SpO2 ≥92% (>95% in pregnancy)
▪️︎Check ABG/VBG
* Patients in extremis should be managed clinically without waiting for arterial blood gases (ABGs). ABGs can aid assessment of hypercapnia or impending respiratory failure: hypercapnia usually does not occur unless PEF is <25% of normal (generally <100 to 150 L/min).
▪️︎Portable CXR
* CXR is generally unhelpful; obtain if complications suspected (eg, pneumonia, pneumothorax), diagnosis is in doubt, or patient is high-risk (eg, IV drug abuser, immunosuppressed, chronic pulmonary disease, heart failure).
▪️︎ECG
*if indicated
▪️︎Albuterol(salbutamol) 2.5 to 5 mg by nebulization every 20 minutes for three doses, then 2.5 to 5 mg every one to four hours as needed, OR give 4 to 8 puffs by metered dose inhaler (MDI) with spacer every 20 minutes for three doses, then every one to four hours as needed.
*Alternatively, for severe exacerbations, 10 to 15 mg can be administered by continuous nebulization over one hour.
■Ipratropium bromide(Atrovent): give 500 mcg by nebulization every 20 minutes for 3 doses OR 4 to 8 puffs by MDI with spacer every 20 minutes for 3 doses; then may administer additional doses hourly as needed for up to 3 hours.
▫️OR - Combivent solution (salbutamol/ipratropium bromide-3mg/0.5mg)
*برای تجویز، کل محتوی ویال (۳ میلی‌گرم سالبوتامول + ۰.۵ میلی‌گرم ایپراتروپیوم) را با سرم فیزیولوژیک تا حجم نهایی ۳ تا ۵ میلی‌لیتر رقیق کرده و با نبولایزر طی ۱۰ تا ۱۵ دقیقه استنشاق می‌شود. این دوز را می‌توان هر ۲۰ دقیقه تا سه بار در ساعت اول (در حمله شدید) و یا حداکثر ۳ ساعت اول تکرار کرد و سپس بر اساس پاسخ بیمار ادامه داد.(هر ۴-۱ ساعت)
*۵۰۰میکروگرم همون ۰.۵ میلی گرم میشه
■Systemic glucocorticoids.
▫️Amp Methylprednisolone 60 to 125 mg IV.
* for patients with impending respiratory failure
OR
▫️Tab prednislolone 40 to 60 mg orally Daily (5-10 days)
* For the majority of less severe asthma exacerbations, give prednisone.
OR
▫️alternatives include: dexamethasone 6 to 10 mg IV or hydrocortisone 150 to 200 mg IV; glucocorticoids may be given IM or orally if IV access is unavailable.
* high-dose inhaled glucocorticoids are not recommended as an alternative to oral glucocorticoid.
▪️︎Amp Magnesium sulfate: 2 g (8 mmol) IV over 20 minutes
*for life-threatening exacerbations and severe exacerbations that are unimproved after one hour of intensive bronchodilator therapy
▪️Epinephrine 0.3 to 0.5 mg IM (eg, 0.3 to 0.5 mL of 1 mg/mL [may be labeled 1:1000] solution) into the mid-outer thigh (vastus lateralis muscle); if needed can repeat every 20 minutes for up to 3 doses; give epinephrine OR terbutaline but not both
* for patients suspected of having an anaphylactic reaction or unable to use inhaled bronchodilators for severe asthma exacerbation.
▫️Terbutaline: may give 0.25 mg by SC injection every 20 minutes times 3 doses for patients unable to use inhaled bronchodilators; give terbutaline OR epinephrine but not both.
▪️Consider intubation
🔹️Appendix:
▪️︎2cc MgSo4 50% IV infusion over 20min (=5cc MgSo4 20% in 100cc D5W)
و یا میتوانیم نبولایزش کنیم که اغلب 3cc/TDS از محلول 20% رو میدن.
▪️قانون کلی jet nebulizer: حتما روی 8-6 L/min اکسیژن میذاریم، دو دارو رو باهم مخلوط نمیکنیم، حداکثر ۴ سی سی میریزیم و دارو رو با نرمال سالین(نه آب مقطر) مخلوط میکنیم.
▪️Empiric antibiotics
Clinical practice guidelines recommend against empiric antibiotic therapy for the treatment of an asthma exacerbation.
اگه نظر/مطلبی دارین بفرمایید.❤️
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