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/

Healthcare Health & Medicine Technology

EmergencyMedicineIreland.com
The Crashing Asthmatic

EmergencyMedicineIreland.com
The Basics
Beta2 agonists +++

EmergencyMedicineIreland.com
Non-response to salbutamol
Genetics vs Tachyphylaxis

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

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