Asthma

Status asthmaticus:
Severe bronchial obstruction is progressive despite
conventional therapy
Severe asthma attack that does not respond to
oxygen or drugs
Severe asthma: asthma who need high doses of
inhaled KS + KS prevent systemic For become
refractory (uncontrolled)

1. Review article: Acute respiratory failure in asthma. http://www.bioline.org.br/pdf?cm05035

2. Limmer D, O'Keefe MF. Emergency Care. 11th ed. Chapter 16.
3. International ERS/ATS Guidelines on Definition, Evaluation, and Treatment of Severe Asthma 2013
 Pathophyisiology of Asthma

Limmer D, O'Keefe MF. Emergency Care. 11th ed. Chapter 16.

 Pathophyisiology
Small bronchioles lung tend to collapse when
deflated harder and longer exhalation of air
trapped in the alveoli wheezing
Exhalation need more power (jd active
process) was advancing fatigue depression
/ respiratory arrest
Wheezing disappeared = severe
bronchoconstriction and deterioration

Limmer D, O'Keefe MF. Emergency Care. 11th ed. Chapter 16.

 Signs and Symptoms
Dyspnea, cough (early signs, deteriorated in the evening)
Wheezing (ekspiratorik); lost as a decline in the heavy air
flow in bronchioles
Tachypnea, tachycardia (weight:> 40,> 120 / min)
The use of accessory muscles
Secondary diaphoresis (+ change in mental status)
Talk per sentence (mild), phrase (medium), word / syllable
(by weight)
Fever, signs of allergy, chest tightness, difficulty sleeping
SpO2 <94%, the symptoms of GER, pulsus paradoxus,
decrease of PEFR

Limmer D, O'Keefe MF. Emergency Care. 11th ed. Chapter 16.

 Signs and Symptoms
80% Slow onset: deterioration 6 hours a few
days
> , triggered by the ISP on, the degree of
inflammation of the bronchioles>, the
response is slow to therapy
20% sudden-onset: deterioration 6 hours
<, triggered by allergens, exercise, stress,
bronchial smooth muscle constriction,
response to therapy > good

Limmer D, O'Keefe MF. Emergency Care. 11th ed. Chapter 16.

 Management of Emergency
Primary Evaluation:
Airway patency O2, CPAP circulation value
Dyspnea O2 supplemental (if not heavy: nasal
cannula) to maintain SpO2 94%
Pregnant / with cardiac disorders SpO2 95%
Severe asthma respiratory failure + 10-12x
ventilation max / min
Beta 2 agonist drug in conjunction with CPAP

Limmer D, O'Keefe MF. Emergency Care. 11th ed. Chapter 16.