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)

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