STEP BY STEP MANAGEMENT OF STATUS ASTHMATICUS

Posted by e-Medical PPT Thursday, August 30, 2012
Asthma History Focus
   A. Asthma symptoms SINCE Or First wheezing episode   
           since/at (age)GIVE SOME  DETAILS  OF  SEVERITY
   B.  Frequency of subsequent symptoms / Seasonality  
           and Course. .”Overall improving , same, worse
           or up and down”
   C. Asthma therapy received / duration / effect.
   D. Symptoms control for the past year.
   E. Asthma Risk Factors (Index) Positive Risk Factors if:
                    -Family hx of asthma / allergies.(parents),
                   - Eczema
                   - Allergies (Pt. and/or Fly),
                   - Eosinophillia in CBC
                   - Smoke exposure, etc.
            - Hx of RSV + bronchiolitis.

ASSESSMENT
Severity of Respiratory distress
Assess cardiovascular compromise. Examples:
 Mild Tachycardia / good perfusion
  HR < than one standard deviation of normal for age.
 Moderate Tachycardia /mild decrease perfusion.
  HR > 1 < than 2 standard deviation of normal for age
 Severe Tachycardic / poor perfusion.
  HR > 2 standard deviation of normal for age
Assess Fluid-Electrolyte and AB Imbalance. Examples:
   (Look for sings of dehydration, hypokalemia, Metabolic acidosis and hyperglycemia)
 Well hydrated / No electrolyte imbalance.
 Mild dehydrated / mild acidosis, lowish K
 Moderate dehydrated / moderate metabolic acidosis (Bic < 17), low K, hyperglycemia, high BUN and Creatitine.

MANAGEMENT
RESPIRATORY SUPPORT
OXYGEN
Assess patient’s oxygen requirements and provide oxygen as needed to keep O2Sat’s > 95% in the acute processes.
Provide Oxygen using the devices as per guidelines
   - Low Flow Oxygen: Nasal Canula < than 3 L/min (~ 35 %)
   - Moderate Flow Oxygen: USE AEROSOLIZE MASK, start with 40 % if switching from nasal canula OR as much as patient needs to keep saturation > 95 %
  - High Flow Oxygen: USE SAME AEROSOLIZE MASK. With this system flow can be adjusted from 28% to 100% just dialing up and down. Besides it delivers humidify oxygen.
If patient’s is requiring > 55 % FiO2 to keep Saturation > 90 %, patient is in HYPOXIC RESPIRATORY FAILURE. NEED TO HAVE AN ABG. (Capillary blood gasses may suffice, NOT VENOUS).
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