1. Special Circumstances Workshop Asthma

2. Learning outcomes By the end of this session the candidate will: Understand how to assess and treat the patient with asthma Recognise the signs and symptoms of severe, life-threatening, and near-fatal asthma Understand the potential complications following tracheal intubation and ventilation

3. 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, SpO 2 86% on 6 litres 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?

4. Case study (continued) Arterial blood gas analysis: Inspired oxygen40% (FiO 2 0.4) estimated normal values PaO 2 51 mmHg> 75 mmHg on air pH7.247.35 – 7.45 PaCO 2 50 mmHg35 – 45 mmHg Bicarbonate20 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?

5. Case study (continued) Clinical course The patient’s trachea is intubated and shortly afterwards there is no palpable pulse What will you do now? - The patient’s trachea is intubated - what considerations to ventilation of the patient are needed?

6. Any questions?

7. Advanced Life Support Course Slide set All rights reserved © Australian Resuscitation Council and Resuscitation Council (UK) 2010