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Extra resources for Acute medicine
Get help quickly. • Does she appear agitated or exhausted? Get help quickly. • Can she speak in full sentences, only in words or is she unable to speak? If only in words or unable to speak, get help quickly. • Is she cyanosed? If she is, she is nearly dead. Respiratory rate must be interpreted in the context of the whole patient: a normal respiratory rate is consistent with imminent death in the asthmatic who is becoming exhausted. Widespread wheezing indicates airways obstruction, but beware the asthmatic who has a silent chest on auscultation: the tidal volume may be reduced so much that insufficient flow is being generated to create a wheeze.
There is no evidence that intravenous hydrocortisone confers additional benefit in acute asthma. Current guidelines recommend concurrent administration of oral and intravenous preparations if patients are very ill and compliant with both forms of therapy. What do you do if the patient does not improve? It is vital that senior clinician support and ICU support is requested sooner rather than later. Do not delay: asthmatics can deteriorate rapidly. If life-threatening features are present or the patient does not improve with the initial treatment after 15 –30 minutes, then further treatments needs to be administered.
Do not delay: asthmatics can deteriorate rapidly. If life-threatening features are present or the patient does not improve with the initial treatment after 15 –30 minutes, then further treatments needs to be administered. 0 g over 20 minutes. This works as a calcium antagonist that induces smooth muscle relaxation. A single dose of intravenous magnesium sulphate has been shown to be effective and safe in acute severe asthma (the safety of repeated doses is yet to be assessed). • Intravenous bronchodilators: aminophylline should be used with caution, especially if oral theophyllines are part of the patient’s regular medication.
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