- even under the best of circumstances, people who have asthma arealways at risk for a bad attack. so, here we talk aboutshort-term treatments. so, i'm going to write asthma attack, and this level of symptoms will usually land thisperson in the hospital. so, this is what we woulddo in the short-term to get them out of that. hopefully, when the symptoms first started
they would have tried the thingsthat usually work for them. they should have triedtheir rescue inhaler with usually it's a beta-2 agonist. beta-2 inhaler didn't work. they could try a nebulizer. nebulizer. or they could trysomething with a steroid. usually, if they're havinga really severe attack, the things they usually do for themselves
won't be helpful. hopefully, in route to the hospital they would have been given some oxygen. since their lungs are reallystruggling to get air in, they need some help staying oxygenated. so, oxygen should be given freely to people who have asthma attacks. okay, so now we're at the hospital, and so far, nothinghas helped this person.
we basically can takesome of the same drugs that you would use at home and upgrade them to the big guns, by making them iv or intravenous. i'm sure you've all had this before. when you got to thehospital, they put a needle with a catheter behind it into your arm, could be your leg, dependingon what's most convenient, and the drug gets infuseddirectly into the bloodstream.
so, the closer a medicinegets to our blood during the delivery, the more pure it is. so, inhaled or ingestedor a pill or something, it takes a while to get there, but directly into our blood,it's going to be fast. so, we can do some of the same things. so, beta-2 or we can do iv steroids. this is really the big guns. we can also do magnesium sulfate,
which is just a chemicalthat also opens up the smooth muscles inour lungs, force it open, and help the patient breathe better. something else we can give is epinephrine or i'm just going to write epi. you've probably heard of people who have bad allergy reactions and carry an epipen. this is sort of the same thing. so, epinephrine in ourbody is usually produced
by the adrenal glands, andepinephrine starts the whole fight or flight emergency response, and it has effects all over the body. so, it can get our eyes to open up, so we can see better during the attack. it can make our heart beat faster, pump more blood to the muscles, and in the lungs, it opens up the airways. so, this person is goingto get heart palpitations
and just feel really panicked,but that's the side effect, because the epinephrinemay save their life by opening up their lungs. epinephrine can be given as an injection, and we usually only givea little bit at a time. so, epinephrine here. at this level, instead ofgiving them just steady oxygen, a few liters through their nose, we might upgrade to masks.
they can either be called cpap or bipap. the difference between these two is how continuous the pressure is. the main thing to rememberwith these is that they both push oxygen into the lungs, just with greater force than you would get with a nasal cannula orjust tubes in the nose. so, this cpap or bipap covers their face and forcefully pushes oxygen in
to help them oxygenate better. at this point, if none of thishave worked for this patient, then we've got to think about intubation. now, intubation is kindof a big procedure. we're going to put a breathingtube down their throat and hook it up to a machine that mechanicallybreathes for this patient, and, of course, that's very uncomfortable, so we have to knock themout with some drugs.
i'm going to draw a breathing tube here. so, this can be a bigprocedure for some people, because they have to be under anesthesia, and intubation itselfis hard on the lungs, but as a last resort, it'snecessary to save people's lives. it can be a hard call ofwhen it's time to intubate. if you intubate too late, they might have permanentdamage from lack of oxygen, or too early, it can hurt the lungs
and put them throughsomething unnecessary. so, at these levelsthere's a question mark of when to go to this step,but when it's necessary and this person is just notresponding to treatment, it's definitely necessaryfor a bad asthma attack. but hopefully, our asthmapatient knows the things that trigger them and avoid them. so, i would say this every time, avoid smoking, eithersecondhand or firsthand.
avoid nsaids. this is your ibuprofen, youraspirin, a lot of painkillers. this can trigger in a lot ofpeople, especially adults. avoid things like allergens, and basically just avoid the triggers. the key is to know yourselfand know what triggers you and stay away from those things. and for our patient here, ifthey've gotten to this level, definitely if they'vegotten to intubation,
they'll probably need to stayin the hospital for a while, to make sure they don'thave another attack and to make sure that theyrecover from this one.