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The Resus Room

Asthma; Roadside to Resus Part 1

The Resus Room

Simon Laing

Science, Emergencymedicine, Medicine, Health & Fitness, Em, Ae

4.8678 Ratings

🗓️ 14 August 2017

⏱️ 30 minutes

🧾️ Download transcript

Summary

Asthma is a common disease and presents to acute healthcare services extremely frequently.

The majority of presentations are mild exacerbations of a known diagnosis and are relatively simple to assess and treat, many being completely appropriate for out patient treatment.

On the other hand around 200 deaths per year are attributable in the UK to asthma, and therefore in the relatively young group of patients there is a real potential for critical illness with catastrophic consequence if not treated effectively. The majority of these deaths occur prior to the patient making it to hospital making the prehospital phase extremely important and hugely stressful in these cases.

It is also worth noting that of the deaths reported that many were associated with inadequate inhaled corticosteroids or steroid tablets and inadequate follow up, meaning that our encounter with these patients at all stages of their care even if not that severe at the point of assessment is a key opportunity to discuss and educate about treatment plans and reasons to return.

In part 1 of this podcast we will run through

  • Pathophysiology
  • How patients present
  • Guidelines
  • Treatment
    • Salbutamol
    • Ipratropium
    • Steroids
    • Magnesium

Part 2 will be out shortly, we hope you enjoy the episode and would love to hear your feedback!

SimonRob & James

References & Further Reading

BTS Asthma Guidelines 2016

Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Goodacre S. Lancet Respir Med. 2013 

Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST. Sauter TC. Emerg Med J. 2017

Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Laan DV. Injury. 2016

TheResusRoom; Needle Thoracostomy podcast

TheResusRoom; BTS Asthma Guidelines 2016 podcast

LITFL; Non-invasive ventilation (NIV) and asthma

Intensiveblog; Asthma mechanical Ventilation Pitfalls

BestBets; In a severe Exacerbation of asthma can Ketamine be used to avoid the need for mechanical ventilation in adults?

Transcript

Click on a timestamp to play from that location

0:00.0

Welcome to the Recess Room podcast.

0:03.9

Five, four, three, two, one, fire.

0:13.0

So hi, and welcome back to The Recess Room podcast. I'm Simon Lang.

0:17.5

I'm Rob Fenwick, and I'm James Yates.

0:19.5

And this is the second of the series of

0:22.6

Roadside to Reesis, which is basically podcast episodes which are trying to really draw together

0:28.1

our different experiences in acute care of patients. So I'm an emergency medicine consultant. Rob is an

0:34.0

ACP with a nursing background in emergency medicine and James is a critical care paramedic.

0:40.0

So a huge thanks, first of all, for the great feedback from our first episode, Acute Heart Failure.

0:46.0

It's absolutely brilliant to hear all your thoughts on the episode, and we hope to bring you lots more useful stuff over the next few episodes.

0:53.4

And again, a big thanks to our sponsors

0:55.7

Abrak for making it all possible, and especially for making James's voice sound that little bit

1:01.5

crisper with a load of new equipment that's just given him. So, we will kick off with our next topic,

1:08.0

then, which is asthma. So, asthma is something that we will all see, be that

1:14.7

pre-hospital or in hospital, day in and day out. The majority of patients we see are going to be

1:21.0

presenting with quite mild presentations of asthma, and the management is going to be relatively simple,

1:27.3

but really, really important.

1:29.7

But that severity of illness really does stretch up to the critically unwell patient.

1:34.5

And a recent inquiry found that there were 200 deaths per year in the UK due to asthma.

1:41.5

So essentially asthma is an inflammatory condition of the airways, causes bronchon

1:46.5

constriction, and essentially patients present with exacerbations of their asthma with a wheeze,

1:51.9

shortness of breath and a real difficulty breathing. The presentation of someone with an acute

...

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