Deep Dive MW R13

* Focused Physical Exam





* Tachypnea and Hypoxemia











* Able to speak in complete sentences











* Accessory muscle use/retractions











* Moving air or quiet on auscultation

















* Basic Treatment Algorithm





* Albuterol Inhaler











* Albuterol/Ipratropium Nebulized (Duoneb)











* Steroids











* IV Magnesium











* Non Invasive Ventilation (CPAP or BiPAP)





* Decreases Work of Breathing

















* Epinepherine

















* Less Common Treatments





* Benzodiazepines











* Ketamine











* Heliox

















* Intubation (Last resort)





* Use a large ETT (8.0)











* Increase the Expiratory Time

















* “Permissive Hypercapnea”





* Appropriate ventilator management of asthma frequently results in mild hypercapnia and respiratory acidosis. IT’S OK

















* Air Trapping





* Results in decreased preload, obstructive shock and pneumothorax











* Suspect with high airway pressures and when waveform doesn’t return to zero (see media)











* Treat by briefly unhooking ventilator and gently pressing on the patient’s chest to get out the trapped air

















* Ventilator Settings





* Decrease the respiratory rate (ex 10)











* Increase the tidal volume (although some hypercapnia is permitted)











* Increase I:E ratio (1:4 or greater)