* 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)