Published on October 13, 2014
1. RESUSCITATION TECHNIQUES IN ASTHMA B Y A N U G O M E M E K A M B B C H , M P H , M S C O C C M E D , I G C N E B O S H
2. WELCOME & INTRODUCTIONS Logistics Emergency exits Restrooms 2
3. AGENDA Introduction Epidemiology Complications of Asthma Management of Cardiac arrest in Asthma Definitive Treatment for Asthma Conclusion References Q&A 3
4. INTRODUCTION Various difficult situations may arise that lead to cardiac arrest. The skill of bystanders is paramount for outcome of survival. Resuscitation will need to be modified in these situations depending on their peculiarities and reversible causes. Early recognition and proper management of Airway Breathing Circulation Disability and Exposure (ABCDE) is very important for survival. Image: ht tp: / / totalassist .co.uk/can-a-cold-cause-a-deadly-asthma-at tack/ 4
5. INTRODUCTION This presentation is a review based on 2010 Guidelines by American Heart Association and European Resuscitation Council. Prior Knowledge of current BLS/ACLS guidelines or resuscitation is assumed. 5 Image: ht tp: / / tebesi te.com/2014/08/get t ing-more-of-your -asthma-medicat ion.html /_65110578_c0020837-_asthma_t reatment_adolescent_-spl
6. EPIDEMIOLOGY Globally over 300million people have asthma[3,4] . Asthma accounts for 1% of morbidity burden worldwide. [3,4] There is an annual mortality rate of 250,000, with a prevalence of 1-18% in Europe. [3,4] It is responsible for 2million Emergency room visits in the United states annually.[3,4] 6 Image 1: ht tp: / /papaheal th.com/ is -asthma-heredi tary/ Image 2: ht tp: / /en.wikipedia.org/wiki /Bronchoconst r ict ion#mediaviewer /Fi le:Blausen_0620_ Lungs_NormalvsInf lamedAi rway.png
7. COMPLICATIONS OF ASTHMA ASPHYXIA This is the leading cause of death here and may arise from the following[3,4]: - severe bronchoconstriction - mucus plugging. The absence of wheeze may imply severe airway obstruction.[3,4] 7 Image 1: http://www.bbc.co.uk/news/heal th -20931946 Image 2: ht tp: / /www.ucdmc.ucdavis.edu/cppn/classes/mechanical_vent i lat ion.html
8. COMPLICATIONS OF ASTHMA CARDIAC ARREST This is rare and may arise after the following.[3,4] - prolonged hypoxaemia, - electrolyte imbalance - drug side effects[3,4] 8 Image 1: ht tp: / /deposi tphotos.com/5730474/stock - i l lust rat ion-asthma-man.html Image 2: ht tp: / /en.wikipedia.org/wiki /Mechanical_vent i lat ion
9. COMPLICATIONS OF ASTHMA Other complications are: BILATERAL TENSION PNEUMOTHORAX [3,4] PNEUMONIA [3,4] ATELECTASIS [3,4] PULMONARY EDEMA [3,4] These can lead to death in this condition.[3,4] 9 Image 1: ht tp: / /www.nlm.nih.gov/medl ineplus/magazine/ issues/ fal l11/ar t icles/ fal l11pg4.html Image 2: ht tp: / / in. reuters.com/ar t icle/2014/07/16/heal th -asthma-drug-idINKBN0FL2WN20140716
10. MANAGEMENT OF CARDIAC ARREST IN ASTHMA In the event of a cardiac arrest arising from asthma, normal BLS and ACLS guidelines are to be followed.[2,3,4] There is need however for - Early endotracheal intubation - Mechanical ventilation, with waveform capnography to ensure and monitor proper tube insertion 10 Image 1: ht tp: / /en.wikipedia.org/wiki /Tracheal_intubat ion Image 2: http: / /www.carefusion.com/medical - products/ respi ratory/vent i lat ion/carefusion -vent i lat ion-system.aspx
11. MANAGEMENT OF CARDIAC ARREST IN ASTHMA -Oxygen should be given at : - A high flow rate - But at reduced respiratory rate with shorter inspiration and longer expiration delivery rate of 1:4 or 1:5 unlike in non-asthmatics.[ 2,3,4] Pleural ultrasound scan(preferable) or Chest X-ray can be used to rule out tension pneumothorax.[3,4] 11 Image 1: ht tp: / /www.bbc.co.uk/news/heal th -11392899 Image 2: ht tp: / /nursing.nmmu.ac.za/Shor t -Courses/Mechanical -Vent i lat ion
12. DEFINITIVE TREATMENT FOR ASTHMA The definitive treatments of value to the patient care consists of the following: Bronchodilators (β2 Agonists short acting) inhaled or IV[3,4] IV Corticosteroids[3,4] Anticholinergics (Ipratropium bromide) inhaled or IV[3,4] Epinephrine Subcut or IM [3,4] Leukotriene receptor Antagonists[3,4] Magnesium sulfate inhaled or IV [3,4] 12 Image 1: ht tp: / /www.doctorwel lgood.com/cl inic -a-z/asthma.html Image 2: ht tp: / /heal thmaven.blogspot .com/2012/02/asthma -drugs-ki l l -more- than-asthma- fda.html
13. DEFINITIVE TREATMENT FOR ASTHMA However use of Methylxanthines: e.g. Aminophylline are NO longer recommended in the management, due to their side effects and a lack of strong evidence of its benefits.[3,4] 13 Image 1: ht tp: / /www.bbc.co.uk/science/0/21857582 Image 2: ht tp: / /www.sciencephoto.com/media/250494/view
14. CONCLUSION Difficult situations may arise or lead to need for resuscitation. Modifications and consideration of reversible factors, including importance of making early decisions to - initiate resuscitation - invite expert and - manage the patient accordingly is paramount to survival in these situations. 14 Image: ht tp: / /www. tacomacc.edu/areasofstudy/career t raining/ respi ratorytherapy/
15. CONCLUSION Mastery and awareness of the basic techniques and guidelines for BLS/ACLS by everyone is crucial to success in resuscitation in theses situations. Get Trained to save lives. 15 Image: ht tp: / /en.wikipedia.org/wiki /Cardiopulmonary_resusci tat ion
16. REFERENCES 1. J.R Casal Codesido, y M.J. Vazquez Lima, 2007; Out-of Hospital Cardiopulmonary Resuscitation: Where are We now? Emergencias 2007;19:295-297. 2. Australian Resuscitation Council; New Zealand Resuscitation Council, 2011; Guideline 11.10 Resuscitation in Special Circumstances: 1-14 3. Jasmeet Soar et al,2010, European Resuscitation Council Guidelines for 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma,anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution; Elsevier Ireland Ltd, Resuscitation 81(2010)1400-1433, doi:10.1016/j.resuscitation.2010.08.015 4. Terry L. Vanden Hoek et al, 2010, Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Circulation.2010:122:S829-S861; doi:10.1161/CIRCULATIONAHA.110.971069; Online ISSN:1524-4539 16
17. . 17 Image:http: / /handsonblog.org/2011/01/26/eight - t ips-for-wr i t ing- the-per fect - thank-you- note/
18. QUESTIONS 18 Image: ht tp: / /www.openbkautoloans.com/wp -content /uploads/2012/04/quest ion - and-answers-bad-credi t -car- f inancing. jpg
Calcification Inhibitors in CKD and Dialysis Patients
Australian Resuscitation Council Guidelines. Navigation. Home. ... First Aid for Asthma - January 2016 ... Pressure Immobilisation Technique - August 2011 ...
Several newspapers have today reported on resuscitation techniques after a new study analysed survival rates using two main approaches. The Daily Telegraph ...
Resuscitation and support of transition of babies at birth; ... in acute severe asthma or a tension pneumothorax); ... Archive. Guidelines 2010.
Part 12: Cardiac Arrest in Special Situations 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Management of Severe Asthma . The following guidelines are intended as general guidelines, and may not be appropriate for all patients or in all ...
www.ifrc.org Saving lives, changing minds. International first aid and resuscitation guidelines 2011 For National Society First Aid Programme Managers,
External chest compression in the management of acute severe asthma--a technique ... Although the technique is not discussed in the Resuscitation ...