Key Points
- Confirm diagnosis early with highest-yield tests (e.g., MRV for CVST, CTA for mesenteric ischemia).
- Dose-and-route precision for high-risk medications; monitor for adverse effects.
- Explicit ICU criteria and consultation triggers.
Clinical Synopsis & Reasoning
Severe, refractory asthma with impending respiratory failure. Use aggressive bronchodilation, systemic steroids, and controlled ventilation with permissive hypercapnia when intubated; consider ketamine, epinephrine, and MgSO₄ as adjuncts.
Treatment Strategy & Disposition
Stabilize airway/breathing/circulation; initiate guideline-concordant first-line therapy; tailor escalation or de-escalation to clinical response and objective metrics; define clear disposition criteria (e.g., ICU triggers, ward acceptability, outpatient safety).
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitating factors
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Anemia/leukocytosis | Context-specific | Trend with therapy |
| BMP | Electrolytes/renal | Derangements common | Renal dosing |
| Condition-specific imaging | See topic | Diagnostic hallmark | Do not delay when red flags present |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Albuterol (neb or MDI) | β2-agonist | Minutes | Frontline bronchodilator (continuous nebs in severe cases) | Tachycardia, tremor |
| Ipratropium | Anticholinergic | Minutes | Add-on for severe exacerbations | Dry mouth |
| Magnesium sulfate | Smooth muscle relaxation | Minutes | 2 g IV over 20–30 min in severe attack | Hypotension, flushing |
| Methylprednisolone | Glucocorticoid | Hours | Systemic anti-inflammatory | Hyperglycemia |
| Ketamine (intubated or severe distress) | NMDA antagonist | Minutes | Bronchodilation & sedation | Emergence reactions, ↑secretions |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy
Patient Education / Counseling
- Explain red flags, adherence, and follow-up plan
References
- Authoritative guideline/review; see internal bibliography — Link