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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, August 21, 2015

Asma severa

Resultado de imagen de First 10 EM
Management of life threatening asthma in the emergency department
First 10 EM - August 18, 2015
first10em severe asthma summary         Summary of ventilator settings for the severe asthma patients

I was inspired by Salim Rezaie of REBEL EM to make some summary images for this post. They certainly aren’t up to Salim’s standards yet – but I will keep trying.
Most asthma deaths are the result of poorly controlled disease that slowly deteriorates over days to weeks. Obviously, the best intervention for these patients would occur long before they arrive in extremis. This is the reason to take all asthma seriously and ensure every patient has follow-up and access to necessary medications.
Although some algorithms include Heliox for status asthmaticus, I have not included it above. There is little evidence to support it. The key problem for patients with life-threatening asthma is that the maximum FiO2 of Heliox is 40%, which may be inadequate. The authors of the Cochrane review conclude: “at this time, heliox treatment does not have a role to play in the initial treatment of patients with acute asthma”, but admit that there may be a role in patients with more severe obstruction, and, as always, note that more study is needed.
IV beta2 agonists: There are two Cochrane reviews, both by Travers (below), that conclude that there is very little evidence to support the use of IV beta2 agonists. Unfortunately, trials generally don’t include the severely ill who are unable to tolerate inhaled beta2 agonist and those are the patients most likely to benefit from an IV route."