Ep 193 The Crashing Asthmatic – Recognition and Management of Life Threatening Asthma

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 2 April 2024

⏱️ 56 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic? What is the role of NIPPV in the management of life-threatening asthma? What are the factors we should consider when it comes to indications for endotracheal intubation of the crashing asthmatic? What role do blood gases play in the decision to intubate? What are the most appropriate ventilation strategies in the intubated asthma patient? and many more... Please support EM Cases with a donation: https://emergencymedicinecases.com/donation/

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.
0:12.7	EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute, the nonprofit organization dedicated to improving EM care through research and education.
0:21.4	The opinions expressed on this podcast are intended for information and education purposes only
0:23.5	and should not be used to diagnose, treat, or prevent any medical condition, nor should they be used
0:25.6	as a substitute for medical advice and qualified practice and physician.
0:28.8	In part one of this two-part podcast series on asthma with Dr. Lior Summer and Samir Mal,
0:33.8	we covered asthma mimics, risk stratification, ED treatment, and who's safe to go home.
0:39.2	We drove home the points that there are many important details in risk stratifying these patients.
0:45.1	We need to make sure that they're on the right medications and have good discharge instructions to
0:48.9	avoid bouncebacks and morbidity.
0:51.4	And although that wasn't the most exciting topic for emergency doctors who don't have
0:56.4	attention spans that are very long, I'm pleased to say that this current podcast will be
1:01.5	a lot more exciting because we're going to be talking about the crashing asthmatic.
1:05.9	Welcome back Dr. Mal and Dr. Summer.
1:08.8	Thank you, sir.
1:09.6	Thank you again.
1:12.2	All right, let's jump into a case.
1:29.3	You get the heads up from dispatch that a 38-year-old woman with a history of asthma has felt more short of breath over the last few hours despite taking her inhalers and that her husband called for an ambulance because she told him in broken sentences that she felt like she was going to die.
1:34.9	She comes rolling into your resuscitation room with the following vital signs.
1:38.8	Heart rate of 130, respiratory rate of 40, oxygen saturation of 88%, and a blood pressure of 150 on 100.
1:48.9	She's tripodting, clearly using respiratory muscles, and looks kind of drowsy.
1:55.0	So Dr. Mal, let's start just with a general overview of your approach to the crashing asthmatic or the about-to-crash-asmodic.
	...

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