Drugs
ED evaluation
Treatment
Wild card
Diagnostic Studies
100
The cornerstone of asthma therapy in the ED
What are short acting beta agonists. Levalbuterol (Xopenex) provides no advantage over less expensive racemic Albuterol.
100
3 features that determine severity of an asthma exacerbation
What are 1. Clinical presentation 2. Peak expiratory flow rates 3. Vital signs
100
This route of administration of a beta agonist is at least as effective and likely more effective than the nebulized route
What is the MDI with spacer
100
Name three pediatric disorders misdiagnosed as Asthma
What are 1. Vocal Cord Dysfunction 2. Croup 3. Bronchiolitis 4 Airway foriegn body 5. Tracheomalacia 6. GERD 7. PNA
100
The less painful and reliable screening test to evaluate for acidosis and hypercarbia in an asthmatic
What is a VBG
200
This drug works by blocking the cholinergic stimulation of airway smooth muscle
What is Ipratroprium Bromide
200
Name 4 cardinal features of severe asthma and/or impending respiratory failure
What are severe agitation/altered mental status, limited air movement with absence of wheezing, severe accessory muscle use with signs of exhaustion, hypercapnia, upright sitting position, hypoxia
200
This combo therapy has shown improvements in pulmonary function measurements and decreased hospitalization rates
What is the combination of Albuterol/Ipratroprium. Most RCTs used 1-3 combo treatments so benefit beyond 3 treatments is unclear.
200
When giving Epinephrine to a severe asthmatic who does not have an IV and is not yet intubated, the preferred route of administration is
What is Intramuscular. It is more rapidly absorped than the Subcutaneous route
200
The history and physical exam will determine if this imaging study is really necessary in an asthmatic patient
What is a CXR
300
Delays in administration of this drug > 1 hour after presentation places patients at higher risk for needing admission.
What is a steroid
300
Labs may be helpful in evaluation of the asthma patient if
What is they have comorbid disease or diagnosis of asthma exacerbation is unclear
300
The most common cause of post intubation hypotension
What is hyperinflation (breath stacking or auto PEEP)
300
The basis on which you decide whether to admit or discharge an asthmatic patient
What is 1. Clinical course 2. Response to therapy 3. Availability of follow up care
300
If you are using peak flow measurements to guide your treatment, what should be your discharge peak flow goal?
What is greater than 70% of predicted
400
A single-dose of this drug, by both oral and intramuscular routes, is as effective as 3-day or 5-day therapy with prednisone.
What is dexamethasone at 0.6mg/kg (up to 18 mg)
400
Risk factors for respiratory failure
What are 1. Noncompliance with meds 2. Prior intubation 3. Long duration of symptoms prior to presentation
400
Your plateau pressure is rising. What should you change on the ventilator first?
What is decrease the respiratory rate
400
This therapy can be useful in severe asthmatics who are not hypoxic after other therapies are attempted
What is Heliox (70% Helium, 30% Oxygen)
400
An ABG indicator of impending respiratory arrest
What is metabolic acidosis
500
Drugs that can be used in a severe asthma exacerbation
What are Magnesium sulfate and Epinephrine. Ketamine can also be used but there are more studies needed to make a recommendation
500
Crucial marker of severity of asthma exacerbation in Peds/Infant patients
What is SaO2. Others include paradoxical breathing, accessory muscle use, cyanosis and respiratory rate >60
500
What are the recommended initial ventilator settings for a patient with asthma who is intubated?
What is Volume controlled setting, TV 8ml/kg, Rate 10, Inspiratory flow rate 80-100 L/Min, Expiratory time 4-5 seconds, PEEP 0 (max 5), FiO2 to keep sat >90%
500
Name 2 ways to assess your ventilated asthmatic for breath stacking
What is 1. Check a plateau pressure during end inspiratory hold 2. Perform an end inspiratory apnea test to measure exhaled breath volume
500
May be used as a substitute for blood gases when evaluating for hypercarbia
What is ETCO2. (Although this lacks validation)
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