TOC |  STAT  | Pulm

ASTHMA - STATUS ASTHMATICUS     See also  Asthma  |  Bronchitis/ COPD |  Asthma/COPD Rx

ABG & chest x ray, bedside spirometry, etc.
* Identify & correct precipitating cause.

A. Bronchodilator Rx

  1. Epinephrine 1:1000 solution 0.3-0.6 ml SQ q30min up to 3x prn.
    Terbutaline 0.25 mg SQ (peak 15-30 min, duration 4-6 h)
    * Avoid or use cautiously in patients with heart disease or hypertension.
  2. Aerosol Rx:
    Proventil (albuterol) 0.5% soln 0.5 ml in 2.5 ml NS q4-6h
    Alupent (metaproterenol) 0.3 ml in 2.5 ml NS q4-6h or
    Bronkosol (isoetharine) 0.5 ml in 2.5 ml NS q4-6h or
    Isuprel (isoproterenol) 1:200 0.5 ml in 2.5 ml NS
    Atrovent (ipratropium) 2 puffs q6h
    Atrovent 0.5 mg (1 unit dose vial) in 2.5 ml NS q6-8h via nebulizer.
  3. Aminophylline IV 5-6 mg/kg loading over 20 min, then infusion at 0.5-0.6 mg/kg/h
    (reduce the dose in CHF, liver disease, elderly, cimetadine pts). Keep level: 10-20 ug/ml.

B. Glucocorticoid Rx:   IV Solumedrol 60-125 mg q6h initially

C. Bronchoscopic removal of mucus plug may be needed.

D. Mechanical ventilator, if:
1. Continuous increase in pCO2 after Rx
2. Continuous deterioration of clinical status, pO2 after Rx
3. Impending respiratory muscle exhaustion
4. Obtundation or coma occurs.

Consider Noninvasive ventilation support as nasal mask/CPAP (Continuous Positive Airway Pressure) or BiPAP bilevel positive airway pressure) with inspiratory pressure of 10 cmH2O and expiratory pressure of 5 cm H2O, adjust by increment of 3 cm H2O to keep paO2 > 90%.

Contraindications to CPAP or BiPAP:
acute facial trauma, agitation, allergy or hypersensitivity to the mask material, coma, excessive airway secretions, hemodynamic instability, high risk of aspiration, inability to cooperate, inability to maintain life-sustaining ventilation if the mask becomes displace, marked cardiac dysrrhythmias, suspected laryngeal or upper airway injury, unstable ventilatory drive.

E. Miscellaneous: * ?? IV infusion of 1.2 gm of magnesium sulfate in 50 ml saline. (JAMA 9/1/89;262:1210 Skobeloff Medical College of Pennsylvania)

F. Supportive care: 1. O2 supplement   2. Hydration   3. Antibiotics if there is suspected infection