Asthma - Emergency Management

Asthma

·        Arrest due to: bronchospasm (® asphyxia), tension pneumothorax (often bilateral), b agonists ® arrhythmias

·        Arrest Prevention:

o  Maximal O2 

o  Nebulised salbutamol (beware overdose ® tachycardia and VF/VT) or iv 5 mg/min up to 20 mg if necessary 

o  IV hydrocortisone

o  Adrenaline

o  IV sodium bicarbonate (acidosis prevents action of sympathonimetics)

o  Intubation and IPPV: sedate with ketamine or benzodiazepines, paralyse with suxamethonium

·        During arrest:

o  Consider assisted exhalation (bilateral manual squeeze over lower chest at end of inspiration)

o  Plus normal routine