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Suggestions for the treatment of acute seizures of asthma

Asthma: an increasingly serious problem

Professor Braman: This is a very important issue. There are amazing 20 million adults and 6 million asthma children suffer from asthma. According to a report by the US Disease Control and Prevention Center in 2015, this disease is in most cases. It can be controlled, but unfortunately, it causes about 3,600 people in the United States each year, including 250 children’s death.

Several high -risk groups need to be treated in these places. Compared with ordinary adults, female asthma patients have a higher incidence, more serious asthma, and more visits for emergency department. Children’s asthma is more than adults. Low -lower socio -economic groups are more likely to diagnose asthma in the emergency room. Those who use illegal drugs, suffering from other complications such as COPD (COPD) and people with mental illness are also high -risk people.

Although we are talking about moderate and severe asthma patients today, another important point that needs to be noted is that one study shows that even mild, intermittent asthma may occur serious, life -threatening, or even death. Although they have stabilized for a while, they only need to be exposed.

These are some statistics that I think we need to consider when we start to explore the treatment of emergency asthma. But first of all, which dangerous signals indicate that patients may need to go to the emergency room?

Asthma control should start in the outpatient clinic, control the disease through patient education and provide sufficient information to patients, and guide patients to provide a asthma action plan to provide in specific conditions.

The asthma action plan includes three parts: green, yellow and red. Once the patient reaches the red area, they should realize that this may need to be diagnosed. I instructed my patients to continue using inhalation agents as before, and used sattamol every 2-4 hours as a short-acting beta receptor agonist. If they use [Sychenol] at least three times and feel bad, it is time for medical help. Some patients have the ability to take oral glucocorticoids. However, if they feel that all these measures are not helpful and they feel badly, they should go to the emergency treatment.

Recognize risk

Professor Braman: If you are a doctor of the emergency room and have severe asthma attacks, I think there are two things that need to be considered. First, you should ask the patient’s history to determine which part of the patient has a high risk of death. Secondly, ask what you see during the examination, whether the patient has a high risk of intubation and even death.

Professor Ramesh: For emergency doctors, it is best to know the background of the patient, thereby increasing the possibility of early prediction. Has patients accepted tracheal intubation? Have you checked the ICU? Did they have at least twice in the past year that need to be hospitalized for acute attacks? Is there at least once an emergency treatment in the past year? Do they use more short -acting β receptors, and use at least two spray tanks a month? All of this indicates that the patient’s condition may be more serious than what we originally expected.

When checking the patient, I think that any laboratory examination or X -ray or other imaging examination is not helpful for acute asthma attacks.

On the contrary, it is important to pay close attention to the patient’s disease indication. What does the patient look like? Are they alertness? Are they talking to you? Does their state of consciousness change? Do they look tired? Do they use the auxiliary muscles? Is there a rib to shrink? The answers to these questions will allow us to quickly understand whether the patient’s condition is serious.

Professor Braman: Another thing to pay attention to is to use the peak peak flow meter. If the patient’s PEF is less than 40 L/min, the patient needs to observe urgently. Besium below 25 L/min, patients may need tracheal intubation and mechanical ventilation. It is also necessary to observe whether the patient’s PEF has improved with time. It should be remembered that the PFE of the patient’s PFE is very simple and useful.

Professor Ramesh: It is very important to combine the two. In addition to PEF, after giving appropriate treatment, the clinical characteristics of patients are often evaluated.

Treatment strategy

Professor Ramesh: Evaluate patients and find that they need to consider three things after they need some fast emergency treatment. First, are patients with hypoxemia? Is SPO2 more than 90%? If not, I usually give the patient oxygen. Secondly, patients should be given a short-acting β2 receptor agonist-sanddamol. Third, if the patient has severe asthma acute attacks, I usually continue atomization 1 H to patients and give oral glucocorticoids. At least 1 dose of IV (Matshage of methyl -based) is my first choice.

Professor Braman: Now most emergency departments now use short-acting β-2 agonist glutamitol, and short-acting anti-choline drugs. After reviewing some studies, there is sufficient evidence that this method can indeed improve the prognosis and even avoid hospitalization, although not all studies. The wide use of this treatment indicates that it may be effective and this is a very safe method for patients.

When it comes to safety methods, one of them is magnesium sulfate, a smooth muscle relaxant, which plays a role by preventing calcium ions from flowing into the smooth muscle. What do you think is the bottom line of magnesium sulfate?

Professor Ramesh: The use of magnesium sulfate is controversial because we have no strong evidence. However, if I have a patient, I have done all the correct things: oxygen absorbing, bronchiectasis, systemic glucocorticoids, but patients still have no improvement or continued bronchial spasm. I usually give 2 grams of magnesium sulfate for more than 20 minutes. Professor Braman: The goal is not to cause damage to the patient, and magnesium sulfate does not cause damage. It can expand the bronchial tube and relieve smooth muscle spasm. As you said, once you do all the jobs, but the patient still has not improved, you should consider the conversion method.

Another problem is the increase in usage. High -flow nasal tube oxygen therapy does not have much evidence support. Studies have shown that patients feel better with nasal oxygen therapy, but what about?

Professor Ramesh: As you mentioned, we have no strong evidence, but the patient feels better and improves breathing. I usually do it for soberness and alert, and I think patients who do not need tracheal intubation.

Professor Braman: When referring to the tracheal intubation, how is the non -invasive ventilation before the tracheal intubation? It is more commonly used. What is the evidence?

Professor Ramesh: There is not much evidence. We do have sufficient evidence to support non -invasive ventilation treatment of acute aggravation or congestive heart failure, or may be used for pneumonia treatment of patients with low immune function, but the evidence of acute asthma ones is not strong. However, I have used it for a while. Similarly, if the patient is awake and alert, and has completed all the above measures, it can give the patient a non -invasive ventilation for about half an hour to an hour. But then, we must decide whether to take care of the patient.

Professor Braman: How do you decide that the patient is serious enough to carry out “tracheal intubation”?

Professor Ramesh: Change of mental state is the first indicator of tracheal intubation for me. Once the ancestral blood gas analysis is performed, if the pH is normal or the carbon dioxide pressure is almost 40, it means that the patient is weak. This is an important point for my tracheal intubation. For the acute attack of asthma, we don’t need to really wait for the patient to have a significant breathing. On the contrary, it is performed in a semi -choice.

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Professor Braman: The hydraulic gas has been used now. Although the evidence is not sufficient, do you use it?

Professor Ramesh: Yes, we do use mixed gas in oxygen, mainly used for intubation patients. I do not agree with patients who have no intubation. The concept behind this is that during the occurrence of asthma, the airflow is turbulent in the airway. Therefore, the use of cymbal oxygen mixed gas may make the air flow more layered, which may make the drug reach the small airway faster. This is the thought behind it. However, as I said, I will not try in non -integrated patients.

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