When the patient can't breathe, and you can't think

[NRSKarenRN, BSN, RN]

December 14th, 2011

Emergency Medicine Updates

When the patient can't breathe, and you can't think: The emergency department life-threatening asthma flowsheet

Life-threatening asthma is uncommon and difficult to study; we may never have better evidence and it's time to add ketamine to the kitchen sink. This flowsheet incorporates ketamine into a stepwise approach to the severe asthmatic for the emergency clinician who may not remember drip rates and vent settings when her own heart rate is 140.

[medicmatt44]

I would like to add that the authors of this algorithm have erroneously replaced continuous nebulization using a continuous nebilizer with continuous nebulization using a standard nebulizer set up.

1) A continuous nebulizer is different than a standard nebulizer. A precise dose and flow rate are required.

2) One could use a standard nebulizer, but modifications to the nebulizer set up are warranted.

Additionally, the algorithm omits the administration of Heliox and inhaled corticosteroids such as Decadron.