Pathophysiology
Therapy
Beta Agonist Therapy
MOA: B2 agonistic effects causing bronchodilation
Albuterol: MDI, Nebulizer, continuous
Terbutaline: IV, IM, SubQ
Epinephrine: IV, IM, SubQ
Home: Albuterol q4hrs
Floors: Albuterol <q4hrs, O2 requirement
PICU: Albuterol <q2hrs, any oxygen with PEEP
Anti-muscarinic cholinergic therapy
MOA: Anti-muscarinic (M3) properties decreasing bronchoconstriction
Steroids for Inflammation
Takes approximately 4-6hrs to take effect
Prednisone converted via liver enzymes to prednisolone before it can work
Prednisolone is a liquid suspension in dextrose which kids love (Cherry flavor, lets goooo)
Caution in diabetes
Magnesium
Inhibits calcium influx into cells, which decreases release of norepinephrine release causing vasoconstriction.
Oxygen Therapy Options
If their saturations are good, they probably aren't hypercarbic
PAO2 = (Patm - PH2O) x FiO2 - PaCO2 / RQ
90 = (713) x 0.21 - PaCO2 / 0.8
-60 = -PaCO2/0.8
PaCO2 = 48
O2 Delivery Systems
Understanding IPAP and EPAP in BiPAP
Standard initial settings 10/5 40%
Do NOT set it and forget it
IPAP: overcoming a resistive airway
EPAP: Keep those stupid alveoli open so gas exchange can occur
Obstructive airway disease is often an IPAP/delta problem
Intubation Strategies
Consider.... not doing it. BUT don't delay in crashing patient
Ketamine as induction agent:
positive hemodynamics
Protects airway reflexes
bronchodilatory effects
but consider whether they actually have catecholamines to release
Remember what does not have analgesic effects (etomidate, Propofol)
Ketamine facilitated vs. DSI vs. RSI
Rescue Therapies
References
Cat Urban
Grace Ker
ChatGPT
DALL-E
Joshua Mcgough, MD