EM - Resp

Question 1

How is a severe asthma exacerbation diagnosed?

Answer 1

Clinical diagnosis, consider and r/o anaphylaxis as a cause of bronchoconstriction

Normal peak flow values differ with sex, height, and age

Peak flow <200L/min usually indicates severe obstruction for most adults

A normal-to-high pCO2 can indicate incipient respiratory failure, as a mild exacerbation will typically result in hyperventilation and a decreased pCO2

Question 2

How is a severe asthma exacerbation treated in adults? Name 5 components of potential treatment.

Answer 2

1) Oxygen as needed
2) Short acting bronchodilators (both Ventolin and Atrovent)
3) Glucocorticoids (oral or IV)
4) MgSO4 in severe cases
5) Ventilatory support as needed

Question 3

Describe the dosing of salbutamol for asthma exacerbation in adults.

Answer 3

1) Via nebulizer:
2.5 mg every 20 minutes x 3
OR
10-15mg over 1 hour

2) Via MDI with Spacer
4-8 puffs (100mcg each) every 20 minutes x3

Question 4

Describe the dosing of ipratropium (Atrovent) for asthma exacerbation in adults.

Answer 4

As differentiating moderate and severe exacerbations is imprecise, ipratropium treatment may be extended to patients with moderate exacerbations based on clinical judgment.

1) Via nebulizer
500mcg every 20 minutes x 3

2) Via MDI with Spacer
4-8 puffs (20mcg each) every 20 minutes x 3

Question 5

When is MgSO4 indicated? What is the dose? What is the potential complication?

Answer 5

Suggested for patients who present with a life-threatening exacerbation or have a severe exacerbation that is not responding to initial therapy

2g IV over 20 minutes

In overdose can cause flaccid paralysis and apnea
Decreased reflexes are the first sign of toxicity
Relatively contraindicated in kidney failure