Hello everyone our case for today is something very important it’s called acute exacerbation of bronchial asthma so the patient will have difficulty breathing grasping for breath so what do you do the first thing that you want to do you want to assess is it is there an inspiratory failure or there isn’t if there is a spider failure and pain impending this pilot
Or table then you do intubation mechanical ventilation admit to the icu you shouldn’t be surprised actually you get cases like this in the exam and to beijing you have to ngo bay don’t be surprised with that intubation and then you administer a prett albuterol approach opium and you administer systemic steroid okay so this is if there is a respecter failure when
There is the oxygen the past ox is really low and pe frs was very low – okay but if there is no suspicion of respiratory failure then you do there so it’s better a failure based on the symptoms there’s chest retractions grasping for breath that patient is unconscious okay that’s respectable but if the patient doesn’t have any of those who just having difficulty
Breathing then you do the peak expected flow rate you look at the peak expiratory flow rate if the peak expected flow rate less than 40 or if it’s more than 40 okay if it’s less than 40 you give oxygen with the goal of pulse ox more than 90 and then you administer a butyl aperture opium iv steroid and reassess peak expiratory flow rate every hour if it’s still low
After four hours then you admit okay this is very important but if the peak expected flow more than 40 then you do oxygen of the pulse ox more than 90 you give albuterol by nebulizer you give oral steroid in this case because it’s not that bad we don’t need systems you’re right you can do it system actor but oral and there is more than 40 okay the peak expiratory
Flow rain doesn’t improve more than 70 after four hours then you admit okay if it didn’t improve in the first one hour you give a petrol pian it didn’t prove after four hours and you give you admit so basically simple for both of them you know oxygen albuterol epic opium and steroids artisan but just make it easy for you i think it should be fine we do because
We do that in real life that’s what it is very simple like an the exam they make it a little bit complicated but in real life that’s easy the decision to admit what is the decision to admit number one is there’s a peak expiratory flow rate less than 40 percent after four hours okay another thing if the peak expiratory flow rate forty to seventy percent at four
Hours then we consider admission okay if the peak is part after more than 70% after at four hours and you just discharged home okay see you in the office come back in the office they’ll be fine okay now let’s walk you through a case first we do in the er you do police ps pulse ox every hour i be excess head elevation cardiac monitor after that you do up focused
Physical exam after the focused physical exam you want to do the abg peak flow because the oxygen is low so you don’t do abg that’s every time you have up oxygen is low peak flow ekg portable chest x-ray cbc with different bmp okay you do albuterol prednisone oral or iv methylene john doesn’t matter and you monitor pulse ox and peak flow you monitor every hour
That’s what we do q long and then you just reevaluate every hour just see do check on him listen to the plank just in a nerve interval history and then if it didn’t improve you can do add a petropia nebulizer and reevaluate every hour 12 3 hours 3 hours same thing you don’t look at the peak is part of flow rate above 70 discharged on less than 70 at man let us
Suppose was less than 70 after focus examining everything you admit you do v panic and big flow every two hours np oid xs normal saline and then they evaluate every two to four hours once the patient improved just counsel him and you do now per mouth you cancel them and peel once he gets better counsel bedrest cardiac monitors and or the normal diet and ampule a
Table so basically it’s very simple just don’t complicate yourself forget all of these just remember initially you do the police bs after that you do the abg and you give him albuterol epitaphium steroid and you do a pulse ox and peak floor every two hours the patient usually gets better than follow them follow up in two weeks if it didn’t get better admit make
Sure that you have the beat panic right i mean you’re ready and you just follow up at this moment so this is the bit a ccs case is very interesting that for each case you there is a treatment specific treatment you do that and then you just follow up that’s it very simple okay thank you so much for listening and we’ll see you on the next one
Transcribed from video
28 Acute exacerbation of bronchial asthma By Ali Kaizen
