Emergency Medicine Board Bombs 267. Crashing Asthmatic: ED Management That Saves Lives
Sep 29, 2025
Wheezing can turn deadly when it goes silent in the ED. Key strategies include using IM epinephrine and recognizing warning signs like silent chest and agitation. Blake discusses the BAC approach—Breathing, Albuterol, Corticosteroids—while emphasizing the importance of BiPAP and high-flow oxygen. He highlights magnesium sulfate and ketamine for severe cases, plus the dangers of high-dose opioids. Intubation, when necessary, should be approached cautiously with specific settings. Essential takeaways focus on rapid management techniques that save lives.
AI Snips
Chapters
Transcript
Episode notes
IM Epinephrine For Crashing Asthmatics
- Give intramuscular epinephrine for crashing asthmatics when they are not responding and becoming hypoxic.
- Repeat up to three times and consider an IV drip only if truly refractory.
Silent Chest Signals Severe Airflow Limitation
- A silent chest (no wheeze) in a distressed asthmatic is a major red flag for impending failure.
- Lack of wheeze often means airflow is too limited for sound, not that disease is mild.
Normalized PaCO2 Can Mask Respiratory Fatigue
- Watch PaCO2 trends: an initial low PaCO2 that normalizes can indicate tiring and failure, not improvement.
- Don't be reassured by a 'normal' CO2 if it rose from a previously low value.