* 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)

Asthma (Deep Dive R13 MW)

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