Coda Change Severe Asthma (How to not kill an asthmatic)
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Apr 16, 2021 Delve into the critical differences in managing severe asthma, where hemodynamic compromise can turn routine situations fatal. Hear a gripping account of a patient's collapse post-intubation and learn about the dangers of breath stacking. Discover the importance of early interventions with epinephrine and non-invasive ventilation. Haney Mallemat emphasizes the need for careful airway management and strategic ventilator settings to prevent further complications. This dialogue sheds light on life-saving techniques and the nuances that can make all the difference.
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Resident's Tragic Intubation Case
- Sarah, a former resident, intubated a young severe asthmatic in a small hospital and the patient arrested minutes later despite prolonged resuscitation.
- Haney Mallemat uses this case to teach how breath stacking and post-intubation management can kill an asthmatic.
Breath Stacking Causes Obstructive Shock
- Life-threatening asthma differs from typical asthma because hemodynamic compromise can kill patients instantly.
- Breath stacking creates positive intrathoracic pressure that causes obstructive shock and can rapidly cause collapse.
Give Epinephrine Early When Inhaled Therapy Fails
- Use intramuscular or intravenous epinephrine when inhaled beta-agonists may not reach constricted airways.
- Don't withhold epi due to tachycardia; bronchodilation often improves vitals once ventilation improves.