The article is about emergency treatment of asthma in the intensive care unit (ICU). Asthma is one of the leading cause of hospitalization in the United States. Asthma is a type of disease which has many triggers and symptoms. Patients respond differently to treatment and depending on their response, hospitals can determine whether patient stay would be long-term or short. Upon admission to the ICU, patient assessment should be obtained, however, it should not delay the treatment. Treatment should include supplemental oxygen as well as short-acting B2-adrenergic agonist and systemic corticosteriods. With mild-moderate asthma, treatment can be implemented using metered-dose inhalers with holding chambers. Albuterol is the go to B2-adrenergic …show more content…
Oral and parenteral also is associated with increased rate of side effects. Inhaled ipratropium is not the go to medication because of its late start of action in the emergency department, but if it's used with short-acting B2-adrenergic can give grater and longer-lasting bronchodilator result. The use of systemic corticosteroids in the emergency department have shown improvement in the lung function, less hospitalization, and less patients coming back to the emergency department after discharge. Guidelines from the national asthma education and prevention program recommends 40 to 80 mg per day in one dose or 2 divided doses. Use of inhaled corticosteroids is not suggested over systemic corticosteroids in the emergency department. Although, the use of inhaled corticosteroids should be implemented in patient long-term care at the time of discharge. Also the use of methylxanthines were once normal for the emergency department is now not suggested due to increased risk of unfavorable events and low outcome of …show more content…
Assessment should focus on patient symptoms, physical examination, and measurement of FEV1 or PEF. Clinically, majority of patients symptoms should improve after the treatment and most will meet the criteria for discharge. Patients who still don't respond to the treatment in the emergency department should be admitted to the hospital for further treatment as needed. Patients with respiratory insufficiency should be considered for immediate intubation and ventilator support. This have to be done with extra care to avoid further complication. It is suggested that "noninvasive positive-pressure ventilator could be considered for patients who decline intubation and selected patients who are likely to cooperate with mask therapy (5)". If FEV1 or PEF is 70% or more after treatment, than patient is clear for discharge from the emergency department. After discharge, patient must still continue to use B2-adrenergic agonist as needed. Oral corticosteroids should also be implemented for 3 to 10 days. Use of oral corticosteroids prevents the risk of relapse. It's very important to educate patients on asthma medications as well as treatment plan to avoid visits to the emergency room. Patients should also be educated to avoid asthma allergence to avoid such attacks. Follow-up appointment is necessary after 1 to 4 weeks after discharge. The use of intravenous magnesium sulfate showed improvement in lung