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  • 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)