Evaluation and management of the critically ill adult asthmatic in the emergency department setting

Asthma is a common reason for presentation to the Emergency Department and associated with significant morbidity mortality. While patients may have relatively benign course, there subset of who present in critical state require emergent management. This narrative review provides evidence-based recommendations assessment management severe asthma. It important consider broad differential diagnosis cause potential mimics asthma exacerbation. Once determined, majority based upon clinical examination. First line therapies exacerbations include inhaled short-acting beta agonists, anticholinergics, intravenous steroids, magnesium. Additional refractory cases parenteral epinephrine or terbutaline, helium‑oxygen mixture, consideration ketamine. Intravenous fluids should be administered, as many these are dehydrated at risk hypotension if they receive positive pressure ventilatory support. Noninvasive ventilation prevent need endotracheal intubation. If mechanical required, it avoid breath stacking by setting low respiratory rate allowing permissive hypercapnia. Patients will intensive care unit admission. focus on emergency clinician.