GIM Question 27 Instructor

A 25 year old man presents to emerge with dyspnea and wheezing on exam. He states that last week he developed a “cold.” He has a 10-year history of asthma. Last year he was admitted to hospital three times for asthma exacerbations, with one ICU admission. He has a personal and family history of atopy.

  1. What information in this patient’s history make you concerned for a severe asthma exacerbation?
    The following information on history are red flags for a severe asthma exacerbation:

    • Several admissions to hospital for asthma exacerbation within the last year
    • Prior ICU admission for asthma exacerbation
  2. What physical exam signs would you look for to determine the severity of his asthma exacerbation?
    The following physical sings indicate a severe asthma exacerbation:

    • Unable to speak in full sentences
    • Respiratory distress
    • Pulsus paradoxus
    • “silent chest”
    • Hypoxia
    • Peak flow <150L/min is very worrisome
  3. What is your acute management of this patient?
    Acute management of an asthma exacerbation includes the following:

    • Stabilize ABCs
    • Short acting beta agonist: Ventolin 4-8 puffs q10min x3
    • Short acting anticholinergic: Atrovent 4-8 puffs q10min x3
    • Steroids: Prednisone 40-80mg PO OD x7-10d
    • O2 supplementation to keep O2 sat > 90%

Lazarus SC. Clinical practice. Emergency treatment of asthma. N Engl J Med. 2010, 363:755-764.

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