Bronchial asthma. First aid for asthma

1. Mortality among patients hospitalized with an attack of bronchial asthma is approximately 1.3%. Careful differential diagnosis is important; the detection of wheezing on exhalation and bronchospasm so clearly indicates “bronchial asthma” that alternatives, such as pulmonary embolism or aspiration, are often simply not considered. The patient’s condition can quickly become threatening; signs of deterioration are retracted intercostal spaces, a sharp decrease or complete cessation of air intake in the respiratory tract, and depression of the patient’s consciousness up to a coma. In this situation, assisted ventilation of the lungs should immediately begin using a facial mask, followed by tracheal intubation and mechanical ventilation in an auxiliary or controlled mode.

2. The priority measures include : determining the forced vital capacity of the lungs (FVC) and the volume of forced expiration in the first second (FEV), although in some cases the determination of these indicators should be postponed until the start of drug therapy. Adequate hydration often contributes to liquefaction of sputum, so it is necessary to establish an intravenous fluid infusion. In patients with an attack of bronchial asthma, hypovolemia is often observed, and hypotension is the main complication. At the same time, the introduction of fluid requires caution because of the danger of pulmonary edema, the occurrence of which can contribute to an increase in negative intrathoracic pressure due to impaired ventilation. Adrenaline at a dose of 0.5 ml (1: 1000) is administered sc. To determine the levels of Ra02, RaC02, pH, serum electrolytes and, if possible, the concentration of aminophylline, it is necessary to obtain a sample of arterial blood. The patient should breathe moistened oxygen (Fi02 = 0.3), as these patients almost always have hypoxemia, which is often exacerbated during treatment. Patients with an attack of bronchial asthma conduct continuous monitoring of ECG and do chest x-ray. Antibiotics are prescribed only with established infectious lung disease. The criteria for improvement are the patient’s well-being, physical examination data and, more objectively, the dynamics of FVC.

3. For inhalation administration , a selective beta-2-adrenergic agonist is usually used, for example, orciprenaline sulfate (up to 10 mg per course), although clinical studies have shown that it has almost no advantage over non-selective drugs, such as isadrine. Correction of metabolic acidosis is carried out by careful administration of sodium bicarbonate. An increase in pH above 7.3 increases the effectiveness of drugs, but at the same time makes it difficult to assess the adequacy of ventilation.

4. The initial dose of intravenously administered aminophylline (6 mg / kg for 20 minutes) should be reduced if the patient has previously taken theophylline-containing drugs. Then start a continuous infusion of 0.5 mg / kg / h; this dose is reduced to 0.2 mg / kg / h in patients with heart failure, liver disease or pneumonia and increased to 0.7 mg / kg / h for smokers. The optimal concentration of theophylline in blood serum is 15–20 μg / ml. One of the many glucocorticoid drugs used in bronchial asthma is hydrocortisone, which is prescribed in an initial dose of 7 mg / kg, and subsequently 7 mg / kg is administered every 8 hours.

5. The lack of effect of the therapy can be a consequence of pneumothorax, which can be detected on the chest x-ray. The effect of the administration of cholinolytics administered by inhalation, for example, atropine (5-8 mg), should be evaluated. Indications for endotracheal intubation are a decrease in the level of consciousness, PaCO2> 60 mm Hg. Art., persistent metabolic acidosis, as well as the weakening or disappearance of respiratory sounds during auscultation. After intubation, the necessary sedative effect can be achieved by the introduction of narcotic drugs and sibazon.

6. Fluorotan is a powerful inhalation drug for anesthesia, which helps to relax the smooth muscles of the respiratory tract. Extracorporeal – membrane oxygenation of the blood allows you to realize the effect of drugs, can also be carried out lavage of the bronchial tree. Extracorporeal oxygenation does not affect mortality.

7. Mechanical ventilation can be stopped if the patient is conscious, contacted and can breathe independently for 45 minutes, providing a PaCO2 level of less than 50 mm Hg. Art. and FVC over 10 ml / kg.

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