Asthma, Adult, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Increased expiratory resistance:

    • Airway inflammation

    • Bronchospasm

    • Mucosal edema

    • Mucous plugging

    • Smooth muscle hypertrophy

  • Consequences:

    • Air trapping

    • Airway remodeling

    • Increased dead space

    • Hype...

Diagnosis

Signs and Symptoms

  • Wheezing

  • Dyspnea

  • Chest tightness

  • Cough

  • Tachypnea

  • Tachycardia

  • Respiratory distress:

    • Posture sitting upright or leaning forward

    • Use of accessory muscles

    • Inability to speak in full sen...

Treatment

Pre-Hospital

  • Recognize the “quiet chest” as respiratory distress.

  • Supplemental oxygen

  • Continuous nebulized β-agonist

  • Administration of IM/SC epinephrine

Initial Stabilization/Therapy

  • Immediate ini...

Follow-Up

Disposition

Admission Criteria

Medical Wards 
  • PEFR <40% and minimal air movement

  • Persistent respiratory distress:

    • Factors that should favor admission:

      • Prior intubation

      • Recent ED visit

      • Multiple ED...

Pearls and Pitfalls

  • Altered mental status in asthma equals ventilatory failure.

  • Patients should be able to demonstrate the correct use of their inhaler or nebulizer:

    • Discharge with a peak flow meter

  • If n...

Additional Reading

  • Camargo  CA Jr, Rachelefsky  G, Schatz  M. Managing asthma exacerbations in the emergency department: Summary of the National Asthma Education and Prevention Program Expert Panel Re...

Codes

ICD9

  • 493.90 Asthma, unspecified type, without mention of status asthmaticus

  • 493.91 Asthma, unspecified type, with status asthmaticus

  • 493.92 Asthma, unspecified type, with (acute) exacerbation

  • 493.9 ...

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