Health alert: Asthma and status
asthmaticus
A patient who is having an
acute asthmatic attack has status asthmaticus which is a potentially fatal,
asthma attack. This is always an emergency situation in which a patient needs
immediate medical treatment. While patient care may vary in hospital emergency
room settings, it is directed towards immediate, medical treatment because the
patient with status asthmaticus is not responding properly to the use of inhalers
and the patient is heading into respiratory failure, very quickly.
Those who are prone to status
asthmaticus may include patients who have poor control over allergies related
to their homes or work environments. They may have been hospitalized, intubated
or treated previously, for asthma symptoms. They may not have been using a peak
flow meter regularly or corticosteroids to maintain control over their asthma.
In fact, they may not have adequate health care and are often subjected to high
levels of stress.
When the patient initially
comes into the emergency unit, he or she will appear to be in obvious
respiratory distress and may have difficulty speaking or be unable to speak in
full sentences. He or she will complain of shortness of breath, as well as
breathlessness when lying down. He or she may be experiencing tightness in his
or her chest.
The patient will have bluish
colored lips and pale nail beds. He or she may appear to be agitated or
confused and may be unable to concentrate. His or her shoulders may be hunched.
The patient may choose to sit or stand, rather than lie down, in order to
breathe better.
The patient may be wheezing or
coughing, but if he or she is having a severe, status asthmaticus attack, he or
she may not be coughing or wheezing at all, because of the lack of air going in
and out of his or her lungs.
Note that these symptoms
indicate severe respiratory distress and pending respiratory failure and are
not the typical symptoms of asthma.
What is asthma?
The National Heart, Lung and
Blood Institute defines asthma as a common chronic disorder of the airways
characterized by variable and recurring symptoms, airflow obstruction,
bronchial hyper-responsiveness (bronchospasm) and an underlying inflammation.
(1)
Patients may have asthma
symptoms for many years, without experiencing acute episodes that are diagnosed
as status asthmaticus.
Failure to treat asthma symptoms properly or early
enough, may result in status asthmaticus which can occur suddenly, without any
warning signs and rapidly progress to asphyxiation.
Diagnosis of a status
asthmaticus patient will include a physician's assessment of the patient's
breathing and lungs, with a stethoscope. The patient's pulse, respirations and
BP will be monitored and recorded. His or her respirations will appear to be
compromised and his or her pulse rate will be elevated.
The patient's level of
alertness and consciousness will be assessed. Note that this patient may be
admitted to the emergency unit, in a semi-conscious state or appear to be on
the verge of the loss of consciousness.
He or she may seem very tired
and demonstrate marked difficulty in obtaining sufficient oxygen. The patient
may have a barrel-shaped chest, typical of asthmatics and show evidence of
tracheal tug or substernal indrawing.
The patient's peak flow rate
and oxygen saturation levels may be assessed and compared to previous records,
if they are available. The immediate administration of oxygen and intravenous
medications may be indicated. Blood work and a chest x-ray may be ordered. The
patient will be checked for symptoms involving the chest, mouth, pharynx and
upper airway as infections and airway obstructions must be ruled out.
The treatment of the status
asthmaticus patient may include an attempt by the patient to use an asthma
inhaler, although he or she is probably not responding to it. If this is the
case, an asthma nebulizer may be indicated, in conjunction with injections of
epinephrine and prednisione.
Other injections may include
the administration of terbutaline and magnesium sulfate to relax the smooth
muscles of the airways. Leukotreine inhibitors or other anti-inflammatory drugs
may be administered, as ordered by a physician.
A ventilator may be necessary
to assist the patient's breathing, if he or she is still not responding to
treatment. A temporary face mask or a breathing tube may be used to administer
treatments. Overnight admission to an intensive care unit may be indicated.
It is important to note that
status asthmaticus attacks can be prevented by the appropriate, early treatment
of asthma symptoms.
Patients with asthma should
have regular medical assessments by their physicians, in order to learn to
control allergens and allergy triggers effectively. They should use
bronchodilators on a regular basis. When asthma symptoms do not respond to
treatment with inhalers, medical advice and assistance should sought by asthma
patients, immediately.
Asthma patients should avoid
contact with those who have throat, sinus and respiratory infections and be
treated for those immediately, if they have become infected. .
Appropriate steps for treating
acute asthmatic episodes in emergency rooms (ERs) are vital for the survival of
patients who have asthma.
Please note that the
information on status asthmaticus has been obtained from the following web
site:
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