A 4-year-old asthmatic child is brought to casualty. She is not speaking and has fast shallow breathing with pulsus paradoxus. ABG shows respiratory acidosis. What is the next best step in management of this patient?
Ans. A Urgent endotracheal intubationRef: CMDT 2019 pg. 256The child is having impending respiratory arrest due to severe exacerbation of asthma. Carbon dioxide narcosis will necessitate elective intubation and ventilation. MildModerateSevereRespiratory arrest imminentSymptoms BreathlessnessWhile walkingAt rest, limits activityAt rest, interferes with conversationWhile at rest, muteTalks inSentencesPhrasesWordsSilentAlertnessMay be agitatedUsually agitatedUsually agitatedDrowsy confusedSings Respiratory rateIncreasedIncreasedOften >30/minute>30/minuteBody positionCan lie downPrefers sittingSits uprightUnable to reclineUse of accessory muscles; suprasternal retractionUsually notCommonlyUsuallyParadoxical thoracoabdominal movementWheezeModerate, often only end expiratoryLoud; throughout exhalationUsually loud; throughout inhalation and exhalationAbsentPulse/minute<100100-120>120BradycardiaPulsus paradoxusAbsent <10 mm HgMay be present 10-25 mm HgOften present >25 mm HgAbsence suggests respiratory muscle fatigue
Urgent endotracheal intubation
Hyperbaric oxygen therapy
MDI with salbutamol and corticosteroids
Terbutaline subcutaneous with aminophylline drip
Respiratory System