- Home
- For clinicians
- Clinical tools
- Respiratory
- Asthma
- The crashing patient: Life-threatening asthma
- Ventilation in the crashing asthmatic
Ventilation in the crashing asthmatic
Keep sat up and on BIPAP until RSI drugs given, then lie down and apply BVM
Place nasal prongs 15L/min for apnoeic oxygenation providing that placement of this does not break your BVM seal for too long
Avoid vigorously bagging patient once intubated. This will lead to dynamic hyperinflation which increases the risk of volu/barotrauma and haemodynamic instability
Administer post-intubation paralysis and ensure patient adequately sedated to aid ventilation
Asthmatic patients are notoriously difficult to ventilate and require ventilation strategies, allowing for permissive hypercapnoea
Suggested initial settings:
SIMV – volume control
FiO2 1.0
Respiratory rate 10-12
TV 6-8ml/kg (ideal body weight)
Inspiratory flow rate 80-100L/min (allows increased time for expiration)
PEEP 0-5cm H2O
I:E ratio 1:4 ideally
Plateau airway pressure <30 cmH2O
Useful resources
‘Dominating the Vent Part II’, EmCrit Lecture, Scott Weingart
-
For clinicians
-
Clinical tools
- Abdominal emergencies
- Advanced life support
- Aged Care
- Airway management
- Anaphylaxis
- Angioedema
- Anticoagulation
- Bites and stings
- Blood and blood products
- Burns
- Cardiology
- Dental Emergencies
- Dermatology
- Deteriorating Patients
- Ear, Nose and Throat
- Electrolytes
- End of Life Care in the Emergency Department
- Endocrine
- Envenomation
- Environmental Health
- Forensic and coronial
- Gastroenterology
- Head injuries
- Imaging: Radiology, MRI & Nuclear Medicine
- Infectious Diseases
- Intellectual Disability
- Mental health
- Neurology
- Managing non-fatal strangulation in the emergency department
- Obstetrics and Gynaecology
- Ophthalmology
- Orthopaedic / Musculoskeletal
- Paediatrics
- Pain management
- Pathology
- Procedural Sedation in the Emergency Department
- Public health alerts and patient safety watch
- Renal
- Respiratory
- Retrieval
- Rural
- Sepsis
- Stroke
- Thromboembolism
- Toxicology
- Transfer, discharge and handover
- Trauma
- Triage and admission
- Ultrasound in the ED
- Urology
- Vascular Emergencies
- Violence, Abuse and Neglect
- Wound Care
- Procedures
- Emergency department fact sheets
- Nurse Delegated Emergency Care
- External Clinical Resources
- Emergency Care Assessment and Treatment
- Models of care
-
Clinical tools
- Research
- Service management
- About the Emergency Care Institute
- Training and education
- Newsletters
- A-Z Directory