Chapter 19 acute Asthma exacerbation

Question 1

What is the differential diagnosis for 36-year-old man presented with dyspnea?

Answer 1

Acute asthma exacerbation, pneumothorax, pneumonia, pulmonary embolism, cardiogenic pulmonary edema, upper airway obstruction (anaphylaxis)

Question 2

Why should this patient have emergent orders done? What would they be?

Answer 2

Life-threatening obstruction is possible; pulse oximetry, oxygen, IV access, elevate head, Cardiac monitor

Question 3

What are the pertinent sxs in physical examination?

Answer 3

Accessory muscle use, inspiratory and expiratory wheezes, hyper residence, equal air entry bilaterally, tachycardia

Question 4

What diagnostic test should be ran for this patient?

Answer 4

Chest x-ray, ABG, PEFR Q1, ECG, CBC BMP, (Sputum culture and D dimer)

Question 5

What PEFR findings are indicative of severe airway obstruction?

Answer 5

PEFR are less than 200 or less than 40% of personal best

Question 6

What would result in this patient becoming admitted, acute asthma exacerbation?

Answer 6

Four hours of treatment without improvement

Question 7

What are the discharged drugs that should be given to this patient?

Answer 7

Tapering oral steroids, inhaled albuterol PRN, inhaled beclomethasone PRN (after completion of oral steroids)

Question 8

What is the appropriate counseling for this patient?

Answer 8

Smoking cessation, asthma care

Question 9

We should be done if respiratory arrest is suspected?

Answer 9

Intubate, mechanically ventilate, admit to ICU.
Administered nebulized albuterol/ipratropium.
Administer systemic steroids

Question 10

What is the management of a patient without impending respiratory arrest however PEF are less than 40% predicted?

Answer 10

Administer oxygen therapy goal pulse ox greater than 90%. Albuterol/ipratropium nebulizer Q20 minutes. IV steroids then gradually taper. Assess PEFR Q1 hour. Admit within four hours if necessary

Question 11

What is the only difference in management for patients with PEF are greater than 40% predicted?

Answer 11

FPEFR doesn’t improve to 70% predicted then add ipratropium

Question 12

How does PEFR determine the decision to admit?

Answer 12

Admit for PEFR less than 40% predicted at four hours. Consider admission for PEFR less than 70% at four hours. Discharge home if PEFR is greater than 70% at four hours