Asthma

Question 1

Foundational treatment for asthma?

Options and doses

Answer 1

Beta-2 agonists (Albuterol)
MDI with spacer: 6-8 puffs equals neb, equally effective, cheaper, easier, teaches patient, good for babies too (screaming sucks in the medication just fine!)
Nebulizer: 0.15-0.3 mg/kg
Can treat Q20min for continuous

Steroids!
Prednisone/Prednisolone: 1–2mg/kg, last 12–36 hrs
Dexamethasone: 0.6mg/kg, last 36–72 hours
Early steroids decrease admission rate

Question 2

What is next move if acute asthma not responding to beta agonist or steroid? Dose?

Answer 2

Magnesium

25–75mg/kg (max 2g) over 20 minutes

Question 3

Apart from beta agonists, steroids, and Mg, what else is an early medication for asthma?

Answer 3

Ipratropium (anti-cholinergic)

Question 4

What are features of the truly sick asthmatic and how is their respiratory status managed?

Answer 4

They are hypoxic—give O2, keep sats >92%

Allow hypercapnea, careful not to over ventilate asthmatics because this is an obstructive process

Question 5

What is a metabolic side effect of beta agonists?

Answer 5

Hypokalemia

Question 6

What is next move if asthmatic is failing interventions and is tiring out?

Answer 6

PPV with BiPAP

Question 7

If asthmatic is not moving air and inhaled beta agonist isn’t working, what else can be given to dilate the airways?

Answer 7

Epinephrine
0.01 mg/kg IM (max0.3–0.5mg)
Q20 min x3

Question 8

What is the use for Heliox in obstructive lung disorders?

Answer 8

Helium has same viscosity, but lower density than Nitrogen making the flow of air more laminar and with less resistance to flow allowing for decreased force required move air

Question 9

What can be a last option for asthma not responding to other therapies?

Answer 9

Ketamine
Decreases edema and is a bronchodilator
However, it is controversial