Title: Management of Acute Attack of Bronchial Asthma in adults in Emergency Room
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3Management of Acute Attack of
Bronchial Asthma(in adults) in Emergency Room
4Initial Assessment
History Physical examination cyanosis -
use of accessory muscles - respiratory rate -
heart rate auscultation. ABG (if patient is
severely distressed).
5 Use of accessory respiratory muscles.
Cyanosis. Respiratory rate gt 36/min. Heart
rate gt 140/min. Inability to speak in
sentences. Silent chest. Differences in
breath sounds over the two sides of the
chest. Agitation. Inability to lie flat.
6No
Yes
- Initial treatment
- Inhaled short acting ß2-agonist by nebulizer
(you can repeat the dose every 20 minutes for one
hour). - O2 therapy to achieve O2sat 90.
- IV Hydrocortisone 100 200 mg.
- Call for Medical Emergency Team .
- O2 therapy 1L/min by nasal prong.
- IV line with saline (slowly).
- Start nebulization by short acting
ß2-agonist. - IV Hydrocortisone 100 200 mg.
7Repeat Assessment (after every dose of
nebulization) Symptoms, Physical Examination.
Incomplete Response
Good Response
Poor Response
8- Good Response
- No distress
- Normal physical examination
- Response sustained 60 minutes after last
treatment
Discharge Home
Continue treatment with inhaled
ß2-agonist. Consider corticosteroid
tablets. Patient education - Take medicine
correctly. - Close medical follow up.
9- Incomplete Response
- Mild to moderate symptoms
- Admit to Hospital Ward
- Inhaled ß2-agonist.
- Inhaled corticosteroids.
- Systemic corticosteroids.
- O2 therapy.
- Consider IV or oral theophylline.
-
Improve
Deteriorate
Discharge home and sustain on tablets and inhaled
medications
Call M.E.T
10- Poor Response
- Severe symptoms.
- Drowsiness and confusion.
- Pco2 45 mmHg.
- Po2 lt 60 mmHg.
-
-
-
Call M.E.T
11Thank You