Acute severe asthma

a life-threatening condition characterized by a sudden worsening of asthma symptoms, including severe shortness of breath, wheezing, and difficulty breathing, often requiring emergency treatment.

Investigations

CBC
ABG if saturations <92% or life-threatening features.
CXR (if suspicion of pneumothorax, infection or life-threatening attack).
Urea and creatinine
Electrolytes

Treatment

Immediate treatment

O2 to maintain sats between 94–98%.
Salbutamol 5mg (or terbutaline 10mg) nebulized with O2.
If severe/life-threatening add ipratropium 0.5mg/6h.
Hydrocortisone 100mg IV or prednisolone 40–50mg oral.

Reassess every 15 minutes

If no or little improvement
Salbutamol nebulizers every 15–30min, or 10mg/h continuously.
Add ipratropium if not already given
Monitor ECG; watch for arrhythmias
Consider single dose of magnesium sulfate (MgSO4) 1.2–2g IV over 20min in those with severe/life-threatening features without good initial response to therapy

If improving within 15–30min

Nebulized salbutamol every 4–6h (+ ipratropium if started in previous step)
Prednisolone 40–50mg oral, once daily for 5–7 days
Monitor O2 sats, aim 94–98% with supplemental if needed
If good improvement 1h after initial treatment, consider discharge with outpatient follow-up

If not improving

Refer to ICU if any of the following signs are present:
- Hypercapnia
- Persistent/worsening hypoxia
- ABG showing low pH or high H+
- Exhaustion, feeble respiration
- Drowsiness, confusion, altered conscious level
- Respiratory arrest

Acute poisoning

Mentions key items in Acute poisoning management and Some specific poisons and their antidotes.

Acute upper gastrointestinal bleeding

Mentions key items in Acute upper gastrointestinal bleeding management.