Last post, we discussed generally the disease of asthma. Today, I’m going to focus on emergency treatment.
The three major problems with asthma are the airway constriction, the inflammation and the mucous production.
Therapy is targeted at reversing these issues.
Treatment starts as follows:
1. Connect the patient to the monitor, determine baseline oxygen level. Normal oxygen saturation is 90-100%. Anything less than 90% is considered hypoxic. If the patient’s oxygen saturation level is less than 90% then they should be placed on oxygen. Now, there are some caveats to this but for your novel, this should suffice.
2. Give breathing treatments. Generally, Albuterol and Atrovent are given together in three back to back nebulizer treatments. This is a medication that is inhaled. Both act to relax the tightened muscles around the airways to ease breathing.
3. Give steroids. This targets the inflammatory response. Most often these are given orally in the form of a syrup (for the little ones) or pills if the patient can swallow. If unable to swallow, then it is given IV.
4. Keep the patient hydrated. This will help clear mucous. The thinner mucous is, the easier it is to cough up.
That’s basic treatment. Now, if the patient doesn’t improve with the above treatment then we will go further. Often times, we will place them on a continuous Albuterol nebulizer. There are also medications that can be given intravenously (IV) to relax the smooth muscle of the airways as well.
Remember, Albuterol is a stimulant. It will be normal for the patient’s heart rate to be elevated and for them to feel quite jittery. These are expected side effects of the medication and it is helpful to explain this to the family.
Asthma pearl: Doctors try very hard not to place an asthma patient on a breathing machine and it is generally considered a last resort to keep the patient from dying. This is a different viewpoint in treating a lot of different medical conditions because generally early intubation is preferred to stabilize the patient.
In respect to asthma, the endotracheal tube (ETT– the thing they stick in your throat) aggravates everything we are trying to reverse. The ETT can cause bronchospasm and increased secretions. Remember, the problem is air trapping. When a patient is on a ventilator– breaths are pushed into the patient via the machine (positive pressure ventilation). This can lead to more air being trapped in the lungs which puts the patient at risk for pneumothorax (which is when the lung get a hole in it and deflates). These patients are ususally medically paralyzed and sedated so their breathing can be totally controlled by the machine.
Have you written an ER scene with an asthmatic in distress presenting as a patient?