Tuesday, November 28, 2017

USMLE Step 3 CCS: Asthma exacerbation

Orders to remember!

Pulse oximetery (every 1-2 hours to access response)
Physical examination
Albuterol nebulizer
Intravenous methylprednisone
Peak flow (every 1-2 hours to access response)
EKG (is this cardiac?)
CXR (to find out cause of asthma excerbation - infection)
CBC (to find out cause of asthma excerbation - infection)

Other stuff:
Cardiac monitor
Head elevation
Ipratropium for severe exacerbations
NSS 0.9%
Discharge on oral prednisone for 5-7 days

- Use inhaled short-acting beta agonists early and frequently, and consider concomitant use of ipratropium for severe exacerbations
- Start systemic glucocorticoids if there is not an immediate and marked response to the inhaled short-acting beta agonists
- Make frequent (every one to two hours) objective assessments of the response to therapy until definite, sustained improvement is documented


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