Brief talk on evidence for treatment strategies in the crashing asthmatic. More info here http://emergencymedicineireland.com/2013/05/the-crashing-asthmatic/

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The Crashing Asthmatic

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The Basics
Beta2 agonists +++

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Non-response to salbutamol
Genetics vs Tachyphylaxis

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Why IV?

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Magnesium
2009
•7 Studies (5 Adult; 2 Kids)
•665 pts

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credit: http://www.freeimageslive.co.uk/

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Aminophylline
2012
•15 Studies
•817 pts

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2012
•3 Studies
•100 pts
IV Salbutamol

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IV Salbutamol
PMID: 16548805

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Now entering an evidence free zone...

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Adrenaline
Neb/IM/SC/IV

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2012
•5 Studies
•206 pts
Non-Invasive Ventilation
↑FRC
↓WOB

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When to intubate?
Wait till you would normally
intubate someone...
Wait some more...
But not too long...

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Intubation
Ketamine
•bronchodilator
•pre and for induction
•? problems with secretions
Lignocaine
•IV and inhaled
•reduced airway responsiveness

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Difficult Ventilation
Credit: http://emcrit.org/podcasts/severe-asthmatic/

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Ventilation
Low PEEP
Adequate flow rates
Really, really big I:E ratios
Deterioration?
•disconnect the vent
•squeeze the chest
•pleural decompression
•fluid loading

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Role for ECMO?

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thanks for watching