1.8 million ed visits yearly in us 100 million lost school/work days can develop at any age 50%...
TRANSCRIPT
1.8 million ED visits yearly in US
100 million lost school/work days
Can develop at any age50% symptomatic by age 6
Pathophysiology—Complex
Airway Inflammation
Intermittent Airflow Obstruction
Bronchial Hyperresponsiveness
Bronchomotor tone balance of adrenergic and cholinergic systems
Beta 2 agonists (Albuterol)◦ Direct bronchodilitation
AntiCholinergic agents (Atrovent)◦ Decreases secretions◦ Bronchodilation
Beta 1 agonists (Epinephrine)
Traditional Prehospital Uses◦ Cardiac (torsades, pulseless v-fib)
◦ OB (PIH,toxemia, ecclampsia, Preterm labor)
◦ Hypomagnesemia
Smooth Muscle Relaxation◦ Decreases influx at calcium channels◦ Decreases neuromuscular transmission via
decreased acetylcholine release at motor endplate
Renal Excretion
Dose 2gm IV over 10 -20 min◦ Dilute in 100cc NS
Which patients benefit?◦ Prolonged, severe asthma with incomplete
response to initial therapies
How do they benefit?◦ Resolution of bronchospasm◦ Lower rates of hospitalization
No Standardized Definition of “Prolonged and Severe” available for EMS
In general—pts in distress and failing to improve with standard initial therapies
Side Effects:◦ CNS and respiratory depressant in BIG doses
◦ Vasodilitation – hypotension Flushing, sweating nausea
◦ Decreased contractility and heart block(Know where your CaCL is…)
Who Can it Hurt?Patients on Digoxin
Patients with PreExisting Heart Block
Patients with Renal Impairment