Asthma: Part 2/2-- Emergency Treatment

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.

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 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?

Asthma: Part 1/2

Recently, I did an overview of diabetes. Here are the links to Part I and Part II. As authors, I think it's good to have a general understanding of the major illnesses so you have a background of whether or not you'd like to afflict your character with it.

Asthma AKA reactive airway disease. Generally, when we think about respiratory disorders, we divide them between the upper and lower part of the respiratory system. The division between the two is generally your larynx or voice box. Upper airway disorders are things such as croup, foreign body, and epiglotitis. Disorders of the lower airway are asthma, bronchiolitis and pneumonia.

There are several things happening in the lowers airways during an asthma attack. There is constriction of the airway as well as inflammation and increased mucous production. It's easier for air to get in than to get out.

Symptoms of asthma can include some or all of the following: Difficulty breathing, wheezing, coughing, low oxygen levels, air hunger, tripod positioning, and pale or blue lips.

In pediatrics, there is reluctance to diagnose asthma under the age of three years. So, even if a child presents with multiple episodes of wheezing, they are likely to be diagnosed as having "reactive airway disease" until they are older and their clinical picture becomes more clear.

The other thing to keep in mind is that all wheezing is not asthma. An upper airway issue can lead to wheezing in the chest. These sounds are deferred. Think a balloon that is stretched to the point where it squeaks as air passes through the tight opening. This can happen in the lungs as well if the larger upper airways are having a problem.

Sometimes, an infection in the lungs (either viral or bacterial) can also lead to wheezing and we will target this wheezing with asthma like therapies. It doesn't mean the person will end up with asthma. It is possible it was just a symptom related to their illness.

However, if the patient develops a picture of wheezing consistently with every viral illness-- then an asthma diagnosis becomes more probable as viral illnesses can be a trigger for the disease.

Next post: Emergency Treatment of Asthma.

Do you have a character that suffers from asthma in your ms?