STATUS ASHMATICUS

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Posted by Unknown Jumat, 23 Desember 2011 0 comments

Asthma

Definition

crhonic obstructivepulmonary disease. Reversible airway obstruction, inflamation, hyperresponsiveness to stimuli.

Pathophysiology

Status asthmaticus

Definition

Severe asthma attack that does not respond to convensional therapy, may result in acute respiratory failure.

Etiologies

Extrinsic : Specific allergy. Dust, dander, pollen, mold, smoke, pollution, food,. Meds : beta blockers, ASA, NSAID, Cold or hot air.
Intrinsic : Specific allergen. Respiratory infection, stress, exercise, aspiration.

Pathophysiology

Extrinsic trigger => lgE released => mast cells or histamine => SRS-A
Intrinsic trigger => impacts balance of sympathetic and parasympathetic ANS.
Histamine and SRS-A => swelling of smooth muscle of large bronchi
Histamine=> excessive mucus
Tachypnea => insersible H20 loss making sputum tenaclous.
Airway narrowing during expiration => hight WOB, fatigue, air trapping
Excessive mucus => V or Q mismath, acute respiratory failure, intrathoracio pressure, may lead to cardiopulmonary arrest.

Clinical Persentation

Axiety, dyspnea, fatigue.
expiratory peak flow rate, prolonged expiration.
Tachypne, Tachycardia, cough, thick tenacious sputum, diaphoresis, accessory muscle use.

Early Stage

ABG decreased PCo2, respiratory alkalosis. Breath sounds : high - pitched exp. wheeze absent, stridor.

Late Stage

ABC decreased PAo2, increased PCo2 or normal. Breat sound : decreased BS, decreased ventilatory effort.

Diagnosis

Infection may be present, dehydration, ECG : ST, CXR : normal or hyperinflated lungs.

Pharmacologic agents

Bronchodilators.

Beta 2 adrenergic agonists : via neb or MIDI (serevent, alupent, proventile )
xanthines : IV (teophyline, aminophyline)
Anticolinergic : augment effect of beta 2 agonists, especially if trigger is intrinsic ( atrovent )
Magnesium : relax smooth muscle

Steroids

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