What's Your Diagnosis? Emergency Department Management of Acute Asthma Exacerbations

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Diagnosis and Management of Acute Joint Pain in the Emergency Department right.

Case Presentation: Emergency Department Management of Acute Asthma Exacerbations

A 43-year-old man with a history of frequent visits for asthma, including multiple admissions and intubations, is brought into the ED. The patient is anxious, tachypneic, using accessory muscles to breathe, and is in severe respiratory distress. On auscultation, air entry is significantly diminished, and he has faint expiratory wheezing. His blood pressure is 155/85 mm Hg; heart rate, 128 beats/min; respiratory rate, 30 breaths/min; temperature, 36.9°C; and oxygen saturation, 91% on 3 L nasal cannula. You place him on a cardiac monitor, begin treatment, and consider what other modalities can be used to avoid intubation…

Case Conclusion

You administered albuterol 10 mg/ipratropium 0.5 mg by continuous nebulizer treatment, methylprednisolone 60 mg IV, and magnesium 2 g IVPB over 20 minutes. The patient became increasingly anxious. You started NIPPV, but he began pulling off the NIPPV mask. You administered ketamine 0.3 mg/kg slowly, and within 5 minutes, the patient appeared calm, with improved respiratory drive. His oxygen saturation improved to 98% and you admitted him to the medical ICU.