Status Asthmaticus

Figure 1 : Asthmatic airways

Source - www.nlm.nih.gov

Presentation

• Persistent shortness of breath
• The inability to speak in full sentences
• Breathlessness even while lying down
• Chest that feels closed
• Bluish tint to your lips
• Tachypnea
• Hypoxemia
• Agitation, confusion, or an inability to concentrate
• Hunched shoulders and strained abdominal and neck muscles
• A need to sit or stand up to breathe more easily

(Mayo clinic. 2014)

Figure 2 : Symptoms of asthma

Source - nurseslabs.com

Causes

• Poor control of allergens such as pollen, airborne allergens, animal dander, mold, cockroaches and dust mites
• Poor control of asthma triggers in the home and/or workplace such as
• Respiratory infections, such as the common cold
• Physical activity
• Cold air
• Strong emotions and stress

(Mayo clinic. 2014)

Figure 3 : Asthma triggers

Source - immunoehealth.com

Investigations

• Assessment of consciousness, fatigue, and the use of accessory muscles of breathing.
• Assessments of respiration rate, wheezing during both inhalation and exhalation, and pulse rate.
• Peak expiratory flow
• Oxygen saturation
• Other physical symptoms will be noticed with the chest, mouth, pharynx, and upper airway.

(WebMD)

Stepwise Management

Fluid replacement

Hydration, with intravenous normal saline is essential. Should pay a special attention to the patient's electrolyte status.

Antibiotics

Administer antibiotics only when they show evidence of infection (eg, pneumonia, sinusitis).

Oxygen monitoring and therapy

Monitor the patient's oxygen saturation which is essential during the initial treatment of status asthmaticus.

Arterial blood gas (ABG) values are usually used to assess hypercapnia during the patient's initial assessment.

Oxygen saturation is then monitored via pulse oximetry throughout the treatment protocol.

Oxygen therapy is essential, with hypoxia being the leading cause of death in children with asthma. Oxygen therapy can be administered via a nasal canula or mask.

Chest tube placement

Chest tube placement may be necessary in the management of pneumothorax.

Figure 4 : Chest tube replacementSource : www.medivisuals1.com

Nitrate oxide

Nitrate oxide has been employed in a child with refractory asthma. The future role of this therapy remains to be determined.

Leukotriene modifiers

Leukotriene modifiers are useful for treating chronic asthma but not acute asthma. This treatment may be beneficial if used via a nebulizer, but it remains experimental.

ICU admission criteria

Indications for ICU admission include the following:

• Altered sensorium
• Use of continuous inhaled beta-agonist therapy
• Exhaustion
• Markedly decreased air entry
• Rising PCO 2 despite treatment
• Presence of high-risk factors for a severe attack
• Failure to improve despite adequate therapy

Surgery

Status asthmaticus is generally managed by means of medical therapy, with some exceptions. For example, thoracostomy is indicated in pneumothoraces.

(Saadeh C. K. & Ryland P. 2014)

REFERENCES

Saadeh C. K. & Ryland P. 2014. Emedicine. [ONLINE] Available at: http://emedicine.medscape.com/article/2129484-treatment [Accessed 27^th April 15].

Mayo clinic. 2014. Mayo clinic. [ONLINE] Available at: http://www.mayoclinic.org/diseases-conditions/asthma/basics/causes/con-20026992 [Accessed 27^th April 15].

WebMD. (nd.) WebMD. [ONLINE] Available at: http://www.webmd.com/asthma/guide/status-asthmaticus [Accessed 27th April 15].