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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -1 مورد

Management of asthma exacerbations in adults: Emergency department or urgent care

Management of asthma exacerbations in adults: Emergency department or urgent care
Features that help with assessment of severity (may or may not be present):
  • Impending respiratory failure:
    • Cyanosis, inability to maintain respiratory effort, depressed mental status, SpO2 <90%
    • PaCO2 >40 mmHg
  • Severe exacerbation:
    • Speaks in single words
    • Sits hunched forward
    • Agitated, diaphoretic
    • Respiratory rate >30 breaths/minute
    • Heart rate >120 beats/minute
    • SpO2 (on air) <90%
    • PEF ≤50% predicted or personal best
  • Mild to moderate exacerbation:
    • Talks in phrases or sentences
    • Prefers sitting to lying
    • Not agitated
    • Respiratory rate 16 to 30 breaths/minute
    • Heart rate 100 to 120 beats/minute
    • SpO2 >90%
    • PEF >50 but <80% predicted or personal best

COPD: chronic obstructive pulmonary disease; FABA: fast-acting beta-agonist (eg, albuterol, albuterol-budesonide, albuterol-beclomethasone, or formoterol-inhaled glucocorticoid combination inhaler); GC: glucocorticoid; ICU: intensive care unit; MDI: metered dose inhaler; PaCO2: carbon dioxide tension; PEF: peak expiratory flow; SABA: short-acting beta-agonist (eg, albuterol); SpO2: pulse oxygen saturation.

* Titrate oxygen to SpO2 93 to 95% for patients with severe exacerbations, particularly if at risk for hypercapnia. Aim for SpO2 >95% in pregnant patients. Titrate to SpO2 88 to 92%, if asthma-COPD overlap.

¶ Magnesium sulfate is 4.06 mmol/g (2 g = 8.1 mmol).

Δ Please refer to the UpToDate topic on treatment of asthma exacerbations in adults.

◊ Adding ipratropium to albuterol nebulizer treatments is preferred for patients with severe exacerbations; alternatively, SABA/ipratropium can be given via MDI four to eight inhalations every 20 minutes, as needed for up to three hours.

§ The dose and duration of therapy can be modified based on the patient's past history of response, severity of exacerbation, and response to current treatment.

Graphic 111835 Version 4.0