Sunday, August 16, 2015

Life Threatening Asthma - Some Pearls and Pitfalls

My talk on Life Threatening Asthma talk in 2nd NECCS Ipoh

Some may not agree with the ventilation strategy I borrowed from Scott Weingart's, i.e., a PEEP of 0 or zEEP.  I guess if you are familiar on how to play around with the PEEP in severe airway obstruction without causing a disaster in barotrauma, then go ahead. But to be on the safe side, I'll stick with the strategy mentioned by Scott Weingart. Listen to the 2nd podcast listed below on Dominating the Vent: Part II for a clearer picture.

Here are the compilation of podcasts and lectures I referred to prepare the talk on asthma:
1. Scott Weingatt's Dominating the Vent: Part I
Download mp4 lecture:

2. Scott Weingatt's Dominating the Vent: Part II
Download mp4 lecture:

**These 2 lectures are very easy to understand and form the basis of ventilation strategy in ED in general. Some people may not agree with Weingart's strategy. Different people have different opinion but Weingart's strategy is very simple - only two strategies that you need to concern in ED: obstructive strategies and lung protective strategies. Even if patient initially does not have lung injuries, ARDS, ALI, the patient may eventually end up with some form of lung injuries if ventilation strategies not appropriate. So, treat the patient as if having a lung injury. Only 4 settings to adjust in ED: TV, IFR, PEEP/FiO2 (use ARDSnet table) and RR.
Notes in pdf is available for download

3. Scott Weingart - Severe asthmatic podcast

4. Scott Weingart - Coding Asthmatic

5. Management of the Crashing Asthmatic

6. RAGE session 3 on life threatening asthma
And RAGEBack session 3:

And here are some of the articles referred to:
1 Oddo M, Feihl F, Schaller MD, et al. Management of mechanical ventilation in acute severe asthma: practical aspects. Intensive Care Med 2006;32(4):501-10.  
2. Alvarez GG, Schulzer M, Jung D, et al. A systematic review of risk factors associated with near-fatal and fatal asthma. Can Respir J 2005;12(5):265-70.
3. Restrepo RD, Peters J. Near-fatal asthma: recognition and management. Curr Opin Pulm Med 2008;14(1):13-23
4. The 3Mg-Trial on the use of MgSO4
Goodacre S, Cohen J, Bradburn M, et al. The 3Mg trial: a randomised controlled trial of intravenous or nebulised magnesium sulphate versus placebo in adults with acute severe asthma. Health Technol Assess 2014;18(22):1-168

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