Asthma exacerbations are usually due to nonadherence of regimens, massive allergen exposures, or hypersensitivities. Exercerbations can present with wheeing, dypsnea, and cough. Identify and treat early asthma exacerbations early so it doesn’t turn into status asthmaticus.
ABC in the ED. Hypoxic patients need supplemental oxygen titrated to be maintained around 94%. High dose short acting beta 2 agonists to open up the airways via metered dose inhaler or nebulizer. We’ll also add short acting antimuscurinic nebs, such as ipratropium, which also has brochodilatory properties and reduces secretions.
Give cortosteroids as soon as possible with albuterol/ipratropium since they all reduce need for hospitalization and ED LOS with earlier administration. Consider adding a bolus of magnesium as it relaxes bronchial smooth muscle to improve airflow.
Guidelines recommend against empiric antibiotics and CXR is more useful for excluding other etioligies. Thirsty for the PHARMFAX? Share this with a friend, and I hope you learned something new.
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