Asthma shortterm treatments | Respiratory system diseases | NCLEX-RN | Khan Academy
26
August

By Adem Lewis / in , , , /


– Even under the best of circumstances, people who have asthma are
always at risk for a bad attack. So, here we talk about
short-term treatments. So, I’m going to write asthma attack, and this level of symptoms will usually land this
person in the hospital. So, this is what we would
do in the short-term to get them out of that. Hopefully, when the symptoms first started they would have tried the things
that usually work for them. They should have tried
their rescue inhaler with usually it’s a beta-2 agonist. Beta-2 inhaler didn’t work. They could try a nebulizer. Nebulizer. Or they could try
something with a steroid. Usually, if they’re having
a really severe attack, the things they usually do for themselves won’t be helpful. Hopefully, in route to the hospital they would have been given some oxygen. Since their lungs are really
struggling to get air in, they need some help staying oxygenated. So, oxygen should be given freely to people who have asthma attacks. Okay, so now we’re at the hospital, and so far, nothing
has helped this person. We basically can take
some of the same drugs that you would use at home and upgrade them to the big guns, by making them IV or intravenous. I’m sure you’ve all had this before. When you got to the
hospital, they put a needle with a catheter behind it into your arm, could be your leg, depending
on what’s most convenient, and the drug gets infused
directly into the bloodstream. So, the closer a medicine
gets to our blood during the delivery, the more pure it is. So, inhaled or ingested
or a pill or something, it takes a while to get there, but directly into our blood,
it’s going to be fast. So, we can do some of the same things. So, beta-2 or we can do IV steroids. This is really the big guns. We can also do magnesium sulfate, which is just a chemical
that also opens up the smooth muscles in
our lungs, force it open, and help the patient breathe better. Something else we can give is epinephrine or I’m just going to write epi. You’ve probably heard of people who have bad allergy reactions and carry an EpiPen. This is sort of the same thing. So, epinephrine in our
body is usually produced by the adrenal glands, and
epinephrine starts the whole fight or flight emergency response, and it has effects all over the body. So, it can get our eyes to open up, so we can see better during the attack. It can make our heart beat faster, pump more blood to the muscles, and in the lungs, it opens up the airways. So, this person is going
to get heart palpitations and just feel really panicked,
but that’s the side effect, because the epinephrine
may save their life by opening up their lungs. Epinephrine can be given as an injection, and we usually only give
a little bit at a time. So, epinephrine here. At this level, instead of
giving them just steady oxygen, a few liters through their nose, we might upgrade to masks. They can either be called CPAP or BiPAP. The difference between these two is how continuous the pressure is. The main thing to remember
with these is that they both push oxygen into the lungs, just with greater force than you would get with a nasal cannula or
just tubes in the nose. So, this CPAP or BiPAP covers their face and forcefully pushes oxygen in to help them oxygenate better. At this point, if none of this
have worked for this patient, then we’ve got to think about intubation. Now, intubation is kind
of a big procedure. We’re going to put a breathing
tube down their throat and hook it up to a machine that mechanically
breathes for this patient, and, of course, that’s very uncomfortable, so we have to knock them
out with some drugs. I’m going to draw a breathing tube here. So, this can be a big
procedure for some people, because they have to be under anesthesia, and intubation itself
is hard on the lungs, but as a last resort, it’s
necessary to save people’s lives. It can be a hard call of
when it’s time to intubate. If you intubate too late, they might have permanent
damage from lack of oxygen, or too early, it can hurt the lungs and put them through
something unnecessary. So, at these levels
there’s a question mark of when to go to this step,
but when it’s necessary and this person is just not
responding to treatment, it’s definitely necessary
for a bad asthma attack. But hopefully, our asthma
patient knows the things that trigger them and avoid them. So, I would say this every time, avoid smoking, either
secondhand or firsthand. Avoid NSAIDs. This is your ibuprofen, your
aspirin, a lot of painkillers. This can trigger in a lot of
people, especially adults. Avoid things like allergens, and basically just avoid the triggers. The key is to know yourself
and know what triggers you and stay away from those things. And for our patient here, if
they’ve gotten to this level, definitely if they’ve
gotten to intubation, they’ll probably need to stay
in the hospital for a while, to make sure they don’t
have another attack and to make sure that they
recover from this one.


11 thoughts on “Asthma shortterm treatments | Respiratory system diseases | NCLEX-RN | Khan Academy

  1. I like the pyramid approach, and know you are keeping this simple, but wonder if you are over-simplifying how CPAP/BiPAP works.  We don't use it to "force Oxygen in" as that isn't the problem with Asthma.  We use it, at least partially, to stint the airways open (CPAP portion), and to reduce to accessory muscles being used (BiPAP).  I'd say for the most part, BiPAP is used over CPAP for an Asthma exacerbation.  Intubating asthmatics is quite complicated – maybe it would be sufficient to say it can be very difficult to get air into (and more importantly, out of) patients lungs during severe exacerbations.  

    Also, as Michael comments, Heliox (a mix of a little bit of oxygen, sometimes the same as Room Air around us, with a larger amount of Helium) can be vital as it changes the density, basically sneaking the oxygen by the areas of constriction.  

    Final thought:  a step up from simply giving a nebulizer is continuous nebulization, where we give larger amounts of bronchodilators like albuterol (up to 10x what we give in a single nebulized dosage).  Combining these (such as giving a continuous nebulizer with heliox with ventilation with IV steroids) is common in more severe cases.  

  2. I like this video, this approach to Asthma treatments look good.
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  3. Could someone explain to me why blacks are affected MORE by Asthma than other races? I was just curious about this but there isn't much information.

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