Acute severe asthma

Diagnosis: The acute severe asthma — the single-word speech, the respiratory rate 32, the heart rate 128, the oxygen saturation 91 per cent (the life-threatening range, below 92 per cent), and the peak flow 35 per cent (the severe range, 33 to 50 per cent). The saturation below 92 per cent crosses into the life-threatening category. The arterial blood gas is indicated to check the carbon dioxide.^[1]

Assessment: ABCDE. The oxygen saturation (continuous), the peak flow (before and after). The arterial blood gas (the carbon dioxide — the normal or the rising is the ominous). The chest radiograph (the pneumothorax exclusion, the delayed if the patient is too unstable). The bloods (the full blood count, the urea and electrolytes — the potassium, as the beta-agonists lower it).^[1]

Management:

1. The high-flow oxygen to the target saturation of 93 to 95 per cent.^[1]
2. The nebulised salbutamol (5 milligrams), driven by the oxygen, repeated every 15 to 20 minutes or the continuous.^[3]
3. The nebulised ipratropium bromide (500 micrograms), added for the severe.^[1]
4. The systemic corticosteroids early — the prednisolone 40 to 50 milligrams orally, or the hydrocortisone 100 milligrams intravenously.^[1]
5. The intravenous magnesium sulphate 2 grams over 20 minutes (the severe unresponsive).^[2]
6. The monitoring for the deterioration — the exhaustion, the silent chest, the rising carbon dioxide — the triggers for the intensive care and the intubation.^[1]
7. The AVOIDANCE of the sedatives.

Disposition: The high-dependency or the intensive care for the severe with the concerning features; the admission until the stability (the peak flow above 75 per cent, the stable on the inhaled therapy).^[1]