Deep Dive MW R13
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 15 October 2023
⏱️ 24 minutes
🧾️ Download transcript
Summary
* Focused Physical Exam
* Tachypnea and Hypoxemia
* Able to speak in complete sentences
* Accessory muscle use/retractions
* Moving air or quiet on auscultation
* Basic Treatment Algorithm
* Albuterol Inhaler
* Albuterol/Ipratropium Nebulized (Duoneb)
* Steroids
* IV Magnesium
* Non Invasive Ventilation (CPAP or BiPAP)
* Decreases Work of Breathing
* Epinepherine
* Less Common Treatments
* Benzodiazepines
* Ketamine
* Heliox
* Intubation (Last resort)
* Use a large ETT (8.0)
* Increase the Expiratory Time
* “Permissive Hypercapnea”
* Appropriate ventilator management of asthma frequently results in mild hypercapnia and respiratory acidosis. IT’S OK
* Air Trapping
* Results in decreased preload, obstructive shock and pneumothorax
* Suspect with high airway pressures and when waveform doesn’t return to zero (see media)
* Treat by briefly unhooking ventilator and gently pressing on the patient’s chest to get out the trapped air
* Ventilator Settings
* Decrease the respiratory rate (ex 10)
* Increase the tidal volume (although some hypercapnia is permitted)
* Increase I:E ratio (1:4 or greater)
Transcript
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| 0:00.0 | Hello, residents. My name is Mike Estefan, and I thank you for joining me today on this month's deep dive episode on the EM Clerkship podcast. |
| 0:11.0 | On this episode, we are going to be diving into asthma. But before we begin, just a quick word from our sponsors over at Pearson Rabbits. |
| 0:19.9 | Pearson Rabbits is my own personal disability |
| 0:22.7 | and life insurance broker. They are a company that primarily helps physicians and other |
| 0:28.1 | healthcare professionals obtain true own occupation disability insurance as well as life insurance. |
| 0:35.2 | None of their agents receive any incentives for pushing one insurance company |
| 0:39.3 | over another. And what that means for you is that you will end up with the plan that is best for you. |
| 0:45.5 | Outside of EM clerkship and our sponsorship deal, I have personally referred a few of my friends |
| 0:50.8 | who are in medicine, as well as my significant other for disability insurance |
| 0:54.6 | through Pearson Ravits. I cannot recommend their services enough. Don't wait until it's too late. |
| 1:01.4 | Schedule a consultation appointment with one of their team members today at www.pearson |
| 1:07.2 | ravits.com. And don't forget to mention EM clerkship when you do. Now, back to the episode. |
| 1:14.8 | This episode is structured backwards from how I normally do these deep dives. I'm going to start off |
| 1:20.2 | by talking about how to clinically assess a patient presenting with an asthma exacerbation, |
| 1:25.1 | meaning the things you should be looking for on exam. |
| 1:32.2 | Then I'll quickly run through all of the treatments that we use in the ED for asthma. |
| 1:37.4 | After laying down that foundation, then I'll break down how I personally, clinically manage my patients presenting with asthma exacerbations in the ER, and then finally we'll end |
| 1:43.3 | by talking about the more advanced topics, |
| 1:45.7 | intubating an asthmatic and the concept of permissive hypercapnia. |
| 1:50.7 | Okay. First, the clinical assessment of the asthmatic. Some of this is obvious and some of this |
| 1:57.3 | is not. But first things first, vital signs are vital. |
| 2:01.7 | Look for tachypnea and hypoxemia. |
... |
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