“Pregnant asthmatic…” Case Conclusion June 7, 2013
Posted by Andy Jagoda, MD in: Airway, Infectious Disease, Respiratory Emergencies , 1 comment so far
While establishing IV access and calling respiratory therapy for your first patient, a 24-year-old Hispanic female with a history of asthma who is 15 weeks pregnant presents with tachypnea and acute shortness of breath with audible wheezing. She has been taking albuterol and fluticasone at home with no relief of symptoms. She has a blood pressure of 110/78 mm Hg, heart rate of 110 beats/ min, respiratory rate of 40 breaths/min, and pulse oximetry of 93% on room air. Physical exam demonstrates accessory respiratory muscle usage, decreased breath sounds, and expiratory wheezing. You recognize that your patient is at risk for deteriorating, and you wonder which interventions are safest to use in pregnancy…
For the 24-year-old pregnant female with a mild asthma exacerbation, you began 3 consecutive metereddose inhaler treatments with albuterol. You also administered 16 mg of dexamethasone orally. Peak flows performed before and after the first treatment were 125 L/min (predicted 235), and auscultation revealed loud expiratory wheezing and better airflow. Peak expiratory flow rate continued to improve, and there was clearing of breath sounds and much-improved airflow. Her respiratory rate was 24 breaths/min at that time, and her heart rate was 108 beats/min. After 2 hours, her symptoms were nearly resolved; you gave her a prescription for repeat dexamethasone with a metered-dose inhaler refill and sent her home.
Congratulations to Dr. Masa, Dr. Samuels, Dr. Woodard Jr., Dr. Flynn, and Dr. Murphy — this month’s winners get a free copy of the latest issue of Emergency Medicine Practice on this topic: Management Of Acute Asthma In The Emergency Department. Didn’t win but want to get a complete systematic, evidence-based review on this topic? Purchase the issue today including 4 CME credits!