Wheezy
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13y/o male
p/w SOB
PMH: asthma
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o/e looks unwell
A: no stridor / angioedema
B: RR60 SaO2 89% 15L O2, marked tracheal tug & SC recession, poor AE B/L, saying words
C: HR 180, warm peripherally
D: alert temp 37.6 -
Life threatening asthma
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Confused/drowsy
Maximal work of breathing, accessory muscle use/recession
Exhaustion
Marked tachycardia
Unable to talk
SILENT CHEST: wheeze may be absent if there is poor air entry
Raised / Normal pCO2
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Involve senior staff early: PIPER, ICU
Oxygen: escalate to CPAP, NIV if exhaustion or RR dropping
Continuous 5mg salbutamol neb
Nebulised 500mcg ipratropium every 20 minutes for 3 doses only
Steriods: methylprednisolone or hydrocortisone IV
Magnesium sulfate IV
Aminophylline load
Consider ketamine bolus follwed by infusion
Consider Adrenaline 10 microg/kg
If ongoing deterioration RSI, prep for rapid hypoxia +/- cardiac arrest on induction, and difficult ventilation afterwards
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