Management of Acute Attack of Bronchial Asthma in adults in Emergency Room

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Management of Acute Attack of
Bronchial Asthma(in adults) in Emergency Room
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Initial Assessment
  History   Physical examination cyanosis -
use of accessory muscles - respiratory rate -
heart rate auscultation.   ABG (if patient is
severely distressed).
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  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.
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No
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.

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Repeat Assessment (after every dose of
nebulization) Symptoms, Physical Examination.
Incomplete Response
Good Response
Poor Response
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• 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.
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• Incomplete Response
• Mild to moderate symptoms

• Admit to Hospital Ward
• Inhaled ß2-agonist.
• Inhaled corticosteroids.
• Systemic corticosteroids.
• O2 therapy.
• Consider IV or oral theophylline.
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Improve
Deteriorate
Discharge home and sustain on tablets and inhaled
medications
Call M.E.T
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• Poor Response
•    Severe symptoms.
•    Drowsiness and confusion.
•    Pco2 45 mmHg.
•    Po2 lt 60 mmHg.
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Call M.E.T
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Thank You