Emergency Department Management of Acute Asthma Exacerbations

Show Notes

• Epidemiology
  • Risk factors for death from asthma (Table 1)
  • Triggers for asthma attacks
  • Variants 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)
  • Medications
    • Oxygen
    • SABA vs LABA
    • What about MDIs?
    • Continuous nebs?
    • Anticholinergics
    • Steroids (IV, oral, inhaled; prednisone vs dexamethasone)
    • Magnesium sulfate
    • Epinephrine
    • Terbutaline
    • Ketamine
  • NIPPV
  • Intubation pearls and pitfalls (Table 8)
• Special populations
  • Pediatrics
  • Pregnancy
  • COVID-19
• Controversies and cutting edge
  • Biologics
  • Fractional exhaled nitric oxide
  • Heliox
  • High flow nasal cannula
  • Delayed sequence intubation
  • ECMO
• Disposition