Episode 66 - Acute Asthma

Episode 66 – Acute Asthma Exacerbations – An Interview with Dr. Steven Hochman and Dr. Brandon SomwaruEMplify – February 2022Emergency Department Management of Acute Asthma ExacerbationsInterview with the authors: Steven M. Hochman, MD, and Brandon Somwaru, DO Episode Outline:* EpidemiologyRisk factors for death from asthma (Table 1)Triggers for asthma attacksVariants of asthma (Table 2)* Differential diagnosis (Table 3)Can PE be a trigger for an acute asthma attack? * Prehospital care* ED care: history (what should we ask?)* ED care: physical exam (what are we looking for?)* Classifying mild/moderate/severe asthma * Lab studies* POCUS (Table 5 and Figure 3)* Peak expiratory flow* ETCO2 capnography and capnometry* Chest x-ray* Treatment (Table 6)MedicationsOxygenSABA vs LABAWhat about MDIs?Continuous nebs?AnticholinergicsSteroids (IV, oral, inhaled; prednisone vs dexamethasone)Magnesium sulfateEpinephrineTerbutalineKetamineNIPPVIntubation pearls and pitfalls (Table 8)* Special populationsPediatrics PregnancyCOVID-19 * Controversies and cutting edgeBiologicsFractional exhaled nitric oxideHeliox High flow nasal cannulaDelayed sequence intubationECMO* Disposition