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/

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The Crashing Asthmatic

  1. 1. EmergencyMedicineIreland.com The Crashing Asthmatic
  2. 2. EmergencyMedicineIreland.com The Basics Beta2 agonists +++
  3. 3. EmergencyMedicineIreland.com Non-response to salbutamol Genetics vs Tachyphylaxis
  4. 4. EmergencyMedicineIreland.com Why IV?
  5. 5. EmergencyMedicineIreland.com Magnesium 2009 •7 Studies (5 Adult; 2 Kids) •665 pts
  6. 6. EmergencyMedicineIreland.com credit: http://www.freeimageslive.co.uk/
  7. 7. EmergencyMedicineIreland.com Aminophylline 2012 •15 Studies •817 pts
  8. 8. EmergencyMedicineIreland.com 2012 •3 Studies •100 pts IV Salbutamol
  9. 9. EmergencyMedicineIreland.com IV Salbutamol PMID: 16548805
  10. 10. EmergencyMedicineIreland.com Now entering an evidence free zone...
  11. 11. EmergencyMedicineIreland.com Adrenaline Neb/IM/SC/IV
  12. 12. EmergencyMedicineIreland.com 2012 •5 Studies •206 pts Non-Invasive Ventilation ↑FRC ↓WOB
  13. 13. EmergencyMedicineIreland.com When to intubate? Wait till you would normally intubate someone... Wait some more... But not too long...
  14. 14. EmergencyMedicineIreland.com Intubation Ketamine •bronchodilator •pre and for induction •? problems with secretions Lignocaine •IV and inhaled •reduced airway responsiveness
  15. 15. EmergencyMedicineIreland.com Difficult Ventilation Credit: http://emcrit.org/podcasts/severe-asthmatic/
  16. 16. 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
  17. 17. EmergencyMedicineIreland.com Role for ECMO?
  18. 18. EmergencyMedicineIreland.com thanks for watching

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