> Just a quick survey:
>
> In a case of severe asthma presentation when patient is not YET a
> definite
> intubation, but close and is moving VERY little air if any and the
> continuous nubeulisers applied are just blowing on his face (assume
> steroids
> have been dealt with), do you
> 1. Nebulise continuously until patient either begins to improve or gets
> too
> exhausted or intubated for another reason?
> 2. Give IV Aminophylline (assume not had it before)?
> 3. Use IV Salbutamol to get some into the system despite him not moving
> any
> resps?
> 4. Use IV/S-cut Epi for same reason as 3.?
> Or any other method?
Remember that steroids are of NO help in the acute phase. Your question needs to be amplified by blood gases. When the asthmatic first presents put a little
local in each wrist in readiness. Then when you take a gas you can guddle around to your heart's content. The decisions are made by the gas. If the patient is
neither hypercapnic nor hypoxic, you can hold a little. They should recover. If they are becoming hypoxic but not hypercapnic then ensure you are driving the
nebuliser with oxygen and if you have given 10mg of nebulised salbutamol give some intravenously. Finally, if the patient has become hypercapnic don't fiddle
at the edges; induce with ketamine (yes, that is what I use) sux and rapid sequence. Then continue with intravenous salbutamol. Do not go near aminophylline,
it has an unacceptably small therapeutic window for its benefits.
Best wishes,
Rowley Cottingham
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