Dr. Andrew Phillips, ED intensivist and founder of EM Coach, discusses intubating asthmatics in the ED. Topics include avoiding intubation, safe intubation techniques, and post-intubation management. They delve into medication administration, treatment comparisons, and strategies for crashing asthmatics, emphasizing the importance of continuous monitoring and collaboration for optimal outcomes.
Early recognition of asthmatic status influences intubation need.
Bronchodilators like Albuterol are crucial in managing severe asthma.
Maintaining proper I to E ratio post-intubation optimizes respiratory care.
Deep dives
Challenging Intubation of Asthmatic Patients
Intubating patients with severe asthma exacerbation is deemed highly challenging and risky due to potential post-intubation complications. Recognizing early signs of status asthmaticus, history of previous intubations for asthma, and timeframe of symptom onset are crucial steps to evaluate the need for intubation.
Pre-intubation Preparation Strategies
Prior to intubation, early recognition of asthmatic status, asthmatics' intubation history, and symptom duration influence pre-intubation preparation. Strategies include preparing intubation equipment promptly and involving the healthcare team for a seamless transition from non-invasive to invasive airway management.
Medication and Therapeutic Management
Administration of bronchodilatory agents like Albuterol and Magnesium is key in managing severe asthma exacerbations. Choices between terbutaline and epinephrine as adjunct agents highlight variation in clinical practices, underscoring the need for individualized patient management.
Ventilator Settings and Respiratory Care Post-Intubation
After intubation, maintaining an appropriate I to E ratio, closely monitoring plateau pressure, and preventing breath stacking are vital to optimize respiratory care. Ventilator alarms such as peak pressure maintenance play a significant role in preventing ventilator-associated complications in asthma patients.
Complications and Physiological Monitoring
Complications such as breath stacking and air trapping necessitate careful respiratory monitoring, including expiratory pressure control and manual vent breaks to maintain hemodynamic stability. Regular assessment of I to E ratios and peak pressures is essential for effective ventilation and patient safety.
There are few things as scary in the Emergency Department as a crashing asthmatic. The stakes go even higher when we are talking about intubating asthmatics. In this podcast we are joined by Dr. Andrew Phillips, and ED intensivist and founder of the awesome board review suite EM Coach, to talk about staving off intubating in asthmatic patients, how to safely intubate them in the Emergency Department, and most importantly, how to manage them after the tube.