Resuscitation in special circumstances workshop Asthma Version: Jun 2016

Learning outcomes At the end of this workshop you should be able to: understand how to assess and treat the patient with asthma recognise the signs and symptoms of acute, severe life-threatening, and near-fatal asthma understand the potential complications following tracheal intubation and ventilation

What action will you take? Case study Clinical setting and history A 58-year-old ‘brittle’ asthmatic is brought in to the hospital with shortness of breath. He is unable to speak and is starting to tire. Clinical course ABCDE A : clear B : RR 30 min-1, PEFR unrecordable, SpO2 85% on 6 L min-1 oxygen via Hudson mask C : P 140 min-1, BP 100/60 mmHg D : unable to speak and starting to tire E : pale and clammy What action will you take? 3

Case study (continued) Arterial blood gas analysis: Inspired oxygen 40% (FiO2 0.4) estimated normal values PaO2 49 mmHg > 75 mmHg on air pH 7.24 7.35 – 7.45 PaCO2 48 mmHg kPa 35 – 45 mmHg Bicarbonate 20 mmol L-1 22 – 26 mmol L-1 Base excess -4 mmol L-1 +/- 2 mmol L-1 What are you going to do now? 4

Case study (continued) Clinical course The patient’s trachea is intubated and shortly afterwards there is no palpable pulse What will you do now? Considerations for ventilation? 5

Case study (continued) Clinical course The patient’s trachea is intubated and shortly afterwards there is no palpable pulse What are the most likely reversible causes and how would you assess for and treat them? 6

Any questions?

Advanced Life Support Course Slide set All rights reserved © Australian Resuscitation Council (June 2016)