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Pulmonary
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Acute Asthma Exacerbation
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SABA + ICS/oral steroids + adjuncts by severity.
Decision
Outcome
Decision
Acute asthma exacerbation. Severity?
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Mild–moderate → inhaled SABA + ipratropium + oral steroid
✓
Severe (PEF <40%, accessory muscles, can't speak in sentences) → continuous SABA + IV steroids + magnesium ± epi
✓
Life-threatening (silent chest, exhaustion, hypoxia despite O₂) → intubate
Outcome
SABA + ipratropium nebs, oral prednisone × 5–7 d
Outcome
Continuous albuterol, IV methylprednisolone, IV magnesium, consider IM epinephrine; admit
Rising PCO₂ in a hypoxic asthma patient is an ominous sign — anticipate respiratory failure.
Outcome
Intubate — low tidal volume, allow permissive hypercapnia, deep sedation; avoid PEEP > 5 if breath-stacking