Chapter 69: Acute Asthma and Status Asthmaticus

Question 1

what is the pathophysiologic hallmark of asthma

Answer 1

• reduction in airway diameter caused by smooth muscle contraction
• vascular congestion
• bronchial wall edema
• thick secretions

Question 2

what is the most common acute asthma stimulus?

Answer 2

Viral acute respiratory infections

Question 3

Risks Factors for Death from Asthma

Answer 3

• Past history of severe exacerbation
• > /= 2 hospitalizations for asthma in the past year
• > 3 ED visits for asthma in the past year
• > 2 canister per month of inhaled short-acting B2 Agonist
• Difficulty perceiving airflow obstruction or its severity
• low socioeconomic status or inner city resident
• illicit drug use
• Psychiatric disease or medical comorbidities

Question 4

Best predictor of hospitalization in patients with acute asthma

Answer 4

comparing repeat either FEV1 or PEFR at ED presentation and 1 hour after treatment

Question 5

Classify: mild, moderate, severe or life threatening

• Dyspnea only with activity
• PEF ≥70% predicted or personal best
• Prompt relief with inhaled SABA

Answer 5

Mild

Question 6

Classify: mild, moderate, severe or life threatening

• Dyspnea interferes with or limits usual activity
• PEF 40%–69% predicted or personal best
• Relief from frequent inhaled SABA. Symptoms for 1–2 d after oral corticosteroids begun

Answer 6

moderate

Question 7

Classify: mild, moderate, severe or life threatening

• Dyspnea at rest; interferes with conversation
• PEF <40% predicted or personal best
• Partial relief from frequent inhaled SABA. Symptoms for ≥3 d after oral corticosteroids begun

Answer 7

Severe

Question 8

Classify: mild, moderate, severe or life threatening

• Too dyspneic to speak; perspiring
• PEF <25% predicted or personal best
• Minimal or no relief from frequent inhaled SABA; IV steroids; adjunctive therapy; needs ED or intensive care unit

Answer 8

Subset:
life-threatening

Question 9

preferred initial therapy for acute bronchospasm

Answer 9

Rapid-onset ß2-adrenergic agonists

*ß2-adrenergic stimulation promotes bronchodilation and vasodilation

Question 10

The most common side effect of β-adrenergic drugs is ___

Answer 10

skeletal muscle tremor

Question 11

TRUE or FALSE: Aerosol therapy with ß2-adrenergic drugs produces excellent bronchodilation and is favored over oral or parenteral routes

Answer 11

TRUE

Question 12

Function of Corticosteroids in Asthma

Answer 12

Corticosteroids produce beneficial effects by restoring β-adrenergic responsiveness and reducing inflammation

*if given within 1 hour of ED arrival in the ED, it reduces the need for hospitalization

Question 13

Management dose of Magnesium sulfate

Answer 13

1 to 2 grams IV over 30 minutes

Nebulization:
- 95 milligrams of nebulized magnesium sulfate in four divided doses 20 minutes apart
- 384 milligrams of nebulized magnesium sulfate in sterile water

Question 14

Management dose of Ketamine in Status Asthmaticus

Answer 14

An IV bolus dose of 0.15 milligram/kg followed by an infusion of 0.25milligram/kg/h is sometimes used

Question 15

Management dose of Epinephrine as adjunct to treat status asthmaticus

Answer 15

Give epinephrine SC or IM, 0.5 milligram, in adults (standard adult EpiPen® dose) for refractory situations