ER Management of Acute Asthma Attack Ahmed Al Gahtani, BSRC, RRT Associate Director, Clinical Education Respiratory Therapy Program Inaya Medical College
ER Management of Acute Asthma Attack
Ahmed Al Gahtani, BSRC, RRTAssociate Director, Clinical EducationRespiratory Therapy Program Inaya Medical College
Asthma exacerbations consist of acute or sub-acute episodes of:
Coughing Wheezing
Progressively worsening SOB
Chest Tightness
Combination
Impending or Actual Respiratory Arrest
Classification of Asthma Exacerbations
SevereMild to Moderate
Mild to Moderate Exacerbation
Symptoms: SOB while at rest, prefers sitting, talk in phrases, and/or usually agitated.
Signs: PEF of ≥ 40%, Increased RR, HR 100 to 120 , use of accessory muscles, loud wheezes throughout exhalation, PaO2 ≥
60 mm Hg and/or PaCO2 < 42 mm Hg, SpO2 90 to 95 %
Severe Exacerbation
Symptoms: SOB while at rest, Sits upright, talk in wards, and usually agitated.
Signs: PEF of < 40%, Increased RR often > 30, HR > 120 , usually uses accessory muscles, loud wheezes throughout inhalation &
exhalation, PaO2 < 60 mm Hg and/or PaCO2 ≥ 42 mm Hg, SpO2 < 90 %
Impending or Actual Respiratory Arrest
Symptoms: Drowsy or confused
Signs: PEF of < 25%, Bradypnea , Bradycardia, Paradoxical thoracoabdominal movement, and Absence of wheezes
(Note: PEF testing may not be needed in very severe attacks)
Early treatment of asthma exacerbations is the best strategy for management. Important elements of early treatment at the patient’s home include a written asthma action plan; recognition of early signs and symptoms of worsening
The NAEPP Expert Panel recommendsthat all clinicians treating asthmatic patients should be prepared to treat an asthma exacerbation, recognize the signs and symptoms of severe and life-threatening exacerbations, and be familiar with the risk factors for asthma-related death. Because infants are at greater risk for respiratory failure, clinicians should also be familiar with special considerations in the assessment and treatment of infants experiencing asthma exacerbations.
Principles and Primary Goals of Care
• Relieve airflow limitation• Treat airway inflammation• Treat hypoxemia or hypercapnia if present.• Non-invasive ventilation / mechanical ventilation in
severe cases (clinical judgment).• Selected therapies: magnesium sulphate and heliox.• Limited or no role for antibiotics and
methylxanthines (aminophylline/theophylline).
Management
Pre-Hospital Management
EMS At Home
All EMS personnel should receivetraining in how to respond to the signs and
symptoms of severeairway obstruction and impending respiratory
failure
ED Management
ED Management
ED Management
Expert Panel Report 3: National Heart Lung and Blood Institute 2007https://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
Noninvasive Mechanical Ventilation
Invasive Mechanical Ventilation
Invasive Mechanical Ventilation
Invasive Mechanical Ventilation
Invasive Mechanical Ventilation
Invasive Mechanical Ventilation
• Heliox• Antibiotics• Systemic Aminophylline• Magnesium Sulfate • Bronchial Thermoplasty
Adjunct Therapies
Am J Respir Crit Care Med. 2012 Apr 1;185(7):709-14
Adjunct Therapies
References
• PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY VOL 6 2009Thank You