Heroic Medical Measures in the Crashing Asthmatic

  1. Pre-oxygenate your patient with high flow nasal cannula at 20 – 30 LPM
  2. Next consider using IM Epinephrine 0.3 – 0.5mg of 1:1000. Severe asthmatics will have a hard time getting inhaled beta agonists into the small airways, but parenteral epinephrine will get into the circulation and get to where it needs to provide support.
  3. Non-Invasive Positive Pressure Ventilation (NIPPV)
  4. Corticosteroids
  5. 2g IV Magnesium and repeat it up to 2 more times over an hour
  6. Give IVF at a dose of 30cc/kg because patients with acute asthma exacerbations because patients will have insensible losses.

…and many more including intubating and ventilating the Crashing Asthmatic Patient…great read.