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A practical guide to the management of medical emergencies - part 5

Nếu không cải thiện sau 15-30 phút, hãy xem xét thêm: thuốc giãn phế quản aminophylline IV 250 mg IV trên 20 phút (không nếu bệnh nhân đã dùng thuốc theophylline miệng) hoặc mg Salbutamol 250 IV hơn 10 phút tiếp theo là một truyền Màn hình điện tâm đồ | CHAPTER 39 257 TABLE 39.2 Immediate management of life-threatening asthma attack Element Comment Obtain help Call for help from a chest physician or senior colleague in medicine and an anesthetist in case urgent endotracheal intubation ventilation is needed Oxygen Give oxygen 60-100 Nebulized bronchodilator Give salbutamol 5mg plus ipratropium 500 pg by oxygen-driven nebulizer repeated every 15-30min Corticosteroid Give prednisolone 50mg PO and hydrocortisone 100mg IV If not improving after 15-30 min consider adding IV bronchodilator Aminophylline 250mg IV over 20 min not if the patient is already taking an oral theophylline or Salbutamol 250 pg IV over 10min followed by an infusion Monitor ECG if IV bronchodilator given Magnesium Magnesium sulfate 1.2-2g IV over 20 min Acute asthma Further reading British Thoracic Society and Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax 2003 58 suppl I Í1-Í94. Holgate ST Polosa R. The mechanisms diagnosis and management of severe asthma in adults. Lancet 2006 368 80-93. 258 SPECIFIC PROBLEMS RESPIRATORY I nj O TABLE 39.3 Further management of acute severe asthma Element Comment Oxygen Give humidified oxygen 40-60 to maintain SaO2 92 Bronchodilator Give salbutamol 5mg plus ipratropium 500 pg by oxygen-driven nebulizer every 30min to 6-hourly as required Switch from nebulized to inhaled bronchodilator therapy when peak flow PF is 75 of predicted best Corticosteroid Continue prednisolone 40-50mg PO daily or hydrocortisone 100mg 6-hourly IV Oral prednisolone should be given until the acute attack has completely resolved no sleep disturbance normal effort tolerance and PF 80 of predicted best As a rule of thumb oral prednisolone should be continued for double the length of time it takes for PF to return to this level to a maximum of 21 days Start inhaled steroid at least 24h before discharge and check inhaler technique Antibiotic therapy Only a minority of asthma attacks are .