* 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)