醫學筆記匯整 ED Notes

- Cough, Decrease activity and appetite, Breathlessness, Dyspnea

- Ominous signs indicating imminent respiratory failure :  
  Diaphoresis, Irritable, Confusion, Drowsiness, Mental status changes

- Tachypnea, Labored breathing, Cyanosis
  Nasal flaring, Accessory muscle use : Subcostal, intercostal, suprasternal retraction

- Expiratory wheezing, prolonged exhalation phase
  Rhonchi and crackles can sometimes be heard
  Decreased breath sounds in some of the lung fields, commonly the right lower posterior lobe, are consistent  with regional hypoventilation caused by airways obstruction.
  Inspiratory and expiratory wheezing
- Silent chest : Sign of severely compromised ventilation and indicates insufficient airflow to generate wheezing

- 3 essential diagnostic questions :

  1. Does this patient have asthma ?
  2. What is the severity of exacerbation ?
  3. Is there a treatable trigger for this exacerbation ?

- SABAs, can repeat every 20 min for 1 hr
- Systemic steroid
  Medason loading : 2 mg/kg/dose
  Maintain 1 mg/kg/dose Q6H

  Prednisone PO : 2 mg/kg within the first hour of ED presentation
  followed by 1 mg/kg/d (maximum 60 mg/d) for the subsequent 4 days to complete a 5-day total course.
  A taper is not required for short treatments.

- O2 keep SpO2 > 94%
- MgSO4 > Xanthium
  MgSO4 dose of 50 mg/kg (maximum 2 g),
  given intravenously and administered over 20 minutes.

- Near Fatal Asthma : BiPAP, Endo

- IV terbutaline, IM Epinephrine