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THE MORNING REPORT

The Best in FOAM Education

  • Joshua McGough, MD

Asthma

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

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