ASTHMA SCENARIO & VIDEOS

You are called to see a 40 year old lady in the emergency department. She was brought in by ambulance and is shaking heavily with a respiratory rate of 43, she looks pale, tired and can barely speak to you as you gather a history. You can hear a wheeze from her chest at the end of the bed. Her blood pressure is 80/20 with a tachycardia of 120 (sinus tachy). Her oxygen saturations are 87% on facemask oxygen at 15L 100%.

1. What are your initial steps in managing this patient?
2. What investigations would you like?
3. What are the signs of severe and life threatening asthma?
4. What pharmacological treatment would you instigate for this lady?
5. What are the BTS guidelines for normal asthma treatment in the community?
6. What is salmeterol?
7. What anti-inflammatory agent is used in asthmatics and how do we use it in an emergency? How long does it take to act?
8. What does a 'silent' chest mean?
9. What might you expect to see on a chest radiograph?

This patient continues to deteriorate and her pulse is now slowing to 60, her BP is 50/20 and her respiratory rate has fallen to 7/min.

1. What are your next actions?
2. Which team members would you like to call? (You have already called for senior help in the department).
3. What might the escalation of care involve for this lady?
4. What might her ABG look like?