Archive for the ‘asthma’ Category

Another case report demonstrates the utility of dissociative-dose ketamine in the deteriorating asthmatic. Life-threatening asthma is uncommon and difficult to study; we may never have better evidence and it’s time to add ketamine to the kitchen sink. This flowsheet incorporates ketamine into a stepwise approach to the severe asthmatic for the emergency clinician who may not remember drip rates and vent settings when her own heart rate is 140. Management of Life-Threatening Asthma in the Emergency Department¬†(pdf) Management of Life-Threatening Asthma in the Emergency Department (png) Regarding nebulized epinephrine: 1:1000 L-epi is 0.1% = 1 mg/ML, so 5 mL = 5 mg. 2.25% racemic epi = 22.5 mg racemic epi per mL = 11.25 mg L-epi (the active isomer) per mL, and we’re using 0.5 mL, which is 5.625 mg L-epi, so roughly ¬†the same dose.

Peak flow normal values

November 25th, 2009
by reuben in asthma

Summary of asthma treatments

November 25th, 2009
by reuben in asthma

Excerpted from MSSM M&M teaching points: * The mainstay of treatment for severe asthma is nebulized albuterol; the initial dose is 5 mg (note this is two bullet packs) x 3 for moderate to severe asthma and continuous nebulized albuterol for life-threatening asthma. Dosing for pediatrics varies, but an easy and reasonable approach is to give half dose for small children (2.5 mg) and full dose for larger children. The important thing is to make lots of smoke. * For severe asthma, anticholinergic therapy should be added to ?2 agonists, the conventional dose is 500 mcg ipratropium bromide (Atrovent), given with the first three albuterol treatments in both adults and children. * Corticosteroids should also be administered to all patients suffering a significant asthma exacerbation. Accepted dosing is 100-200 mg IV methylprednisolone per day or 40-60 oral prednisone per day. Pediatric dosing varies, but a dose of 1 mg/kg for both preparations is often used. * In cases of severe asthma, it is not necessary to push oxygen saturation above 90-92%. * In cases of severe asthma, data supports the use of intravenous magnesium. The dose is 2 g in adults and 50 mg/kg in children, infused over 20 minutes. Magnesium does not benefit patients with mild or moderate asthma. * In cases of life-threatening asthma, consider subcutaneous or intramuscular epinephrine, especially in younger patients with good hearts. The dose is .3-.5 mg of the 1:1000 preparation (1 mg/mL). Pediatrics dose is .01 mg/kg. * Non-invasive ventilation is of proven benefit in severe asthma, in…

ketamine dose comes from Denmark, Crane, Brown. Ketamine to avoid mechanical ventilation in severe pediatric asthma. J Emerg Med 2006;30:2 163-166

prednisone

that last value should be <91%