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The Crashing Asthmatic
 

The Crashing Asthmatic

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Brief talk on evidence for treatment strategies in the crashing asthmatic. More info here http://emergencymedicineireland.com/2013/05/the-crashing-asthmatic/

Brief talk on evidence for treatment strategies in the crashing asthmatic. More info here http://emergencymedicineireland.com/2013/05/the-crashing-asthmatic/

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    The Crashing Asthmatic The Crashing Asthmatic Presentation Transcript

    • 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.com credit: http://www.freeimageslive.co.uk/
    • EmergencyMedicineIreland.com Aminophylline 2012 •15 Studies •817 pts
    • EmergencyMedicineIreland.com 2012 •3 Studies •100 pts IV Salbutamol
    • EmergencyMedicineIreland.com IV Salbutamol PMID: 16548805
    • EmergencyMedicineIreland.com Now entering an evidence free zone...
    • EmergencyMedicineIreland.com Adrenaline Neb/IM/SC/IV
    • EmergencyMedicineIreland.com 2012 •5 Studies •206 pts Non-Invasive Ventilation ↑FRC ↓WOB
    • EmergencyMedicineIreland.com When to intubate? Wait till you would normally intubate someone... Wait some more... But not too long...
    • EmergencyMedicineIreland.com Intubation Ketamine •bronchodilator •pre and for induction •? problems with secretions Lignocaine •IV and inhaled •reduced airway responsiveness
    • EmergencyMedicineIreland.com Difficult Ventilation Credit: http://emcrit.org/podcasts/severe-asthmatic/
    • EmergencyMedicineIreland.com Ventilation Low PEEP Adequate flow rates Really, 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