Management of Bronchospasm / Laryngospasm Flashcards
Signs of bronchospasm in an intubated patient:
1. Increased peak airway pressures. 2. Wheezing on lung exam. 3. Increased expiratory time. 4. Increased ETCO2 with upsloping ETCO2 waveform. 5. Decreased tidal volumes if pressure control.
Bronchospasm treatment: Vent changes
- Increase to 100% O2, high flow.
- Change I:E ratio to allow for adequate exhalation.
patients who develop sudden
hypotension may be air-trapping – disconnect
patient from the circuit to allow for complete exhalation.
Troubleshooting problems that may present similar to bronchospasm
Rule out problems with ETT via auscultation & suction
catheter (mainstem intubation, kinked ETT, mucus plug)
Rule out anaphlyaxis
Bronchospasm treatment: Inhaled agents
Give a Beta 2 agonist (albuterol, multiple puffs required)
and possibly an anticholinergic (Ipratropium).
consider nebulized racemic epi
Bronchospasm treatment: IV meds
- If severe consider epinephrine (start with 10 mcg IV and escalate, monitor for tachycardia and hypertension)
- Consider ketamine: 0.2 – 1.0 mg/kg IV
- Consider hydrocortisone 100 mg IV.
Nerve associated with Laryngospasm
Superior Laryngeal N.
Treatment of laryngospasm
forward displacement of the jaw and positive pressure ventilation with 100% oxygenation is often effective in breaking spasm
- hypoxia and hypercarbia that develop will decrease postsynaptic potentials and brainstem output to the superior laryngeal nerve
- laryngospasm will eventually cease as hypercarbia and hypoxia develop
Treatment of severe laryngospasm
may require small doses (20mg IV) of Sux and re-intubation
Sux may be given IM (40-60mg) or SL
Bronchospasm: differential dx
Is this anaphylaxis?!
Discontinue potential allergens: muscle relaxants, latex, antibiotics, protamine, blood products, contrast, chlorhexidine…
- Give fluid bolus
- Give Epi at escalating doses 10mcg-100 mcg IV
- Start epi infusion
- consider additional IV access and invasive monitors
- H1 antagonist (diphenhydramine 25-50 IV)
- H2 antagonist (Ranitidine 50 IV)
- Corticosteroids (methylpred 125 IV)