O o o O: Emergency Management Status Asthmaticus

Respiratory-Airway and Ventilatory
Emergency Management
Status Asthmaticus
A 48yo male pt w/ status asthmaticus has just

been transferred to ICU from the ER. The pts
wife claimed that his husband has been
experiencing bouts of asthma for several
days, which have not relieved by using his
inhaler. The pt is experiencing severe dyspnea
and wheezing. He is restless and very fearful.
After assessing the pt and reviewing his ABGs,
the MD decides to intubate the pt and
attached to Mechanical Ventilation.
Common problems found in ER:
1. Status asthmaticus
2. BA( COPD)
3. Pneumothorax
4. ARSD ( Acute Resp Distress Syndrome)
5. Pulmonary Edema
6. Pulmonary embolism
7. Atelectasis-ambulate and deep
breathing exercises in postop is
essential to prevent hypoventilation
and collapse of the lung
tissue( atelectasis.
So, one of the most problemcommon in ER is
Status Asthmaticus.
is characterized by an acute episode of

bronchospasm that greatly increases the
workload of breathing.
10% of this case require tx in an ICU
Pathophysiology: Involves decreased

diameter of the bronchi, and ventilationperfusion abnormality.
Clinical Overview:
Is a severe, persistent, and lifethreatening attack of asthma, which is
refractory to regular treatment, and may
require the use of mechanical ventilation
o Signs and symptoms
Severe
inspiratory
and
Fear
Death anxiety
Ineffective management of therapeutic
expiratory wheezing
Non-productive cough
Orthopnea
Nasal flaring
Deminished breath sounds
Sinus tachycardia
Goals of Collaborative Management:

1. Immediate recognition and Emergency
treatment.
2. Correcting hypoxemia
3. Improving ventilation
4. Preventing respiratory failure
Nursing Diagnosis-actual potentials
Ineffective breathing pattern.
Ineffective airway clearance.
Risk for infection
regime.
Dx & Lab. Test
2. Inhaler
3. Theophylline or Aminophylline
Hx
Pulmonary function test
ABG
CX-ray
Pulse Oximetry
ECG
4. O2 required
Nursing Management:
Position: high fowlers
Adm humidified low-flow O2 via
venturi mask or nasal cannula
Care for: IV, Meds, Intubation,
M.V.
Health teaching plan during
attack.
Pharmacology
1. IV corticosteriods
Complications:
Resp. Acidosis
Ventricular Arrthythmias
3. Secretions- facilitates removal of secretions

via suctioning
Metabolic Acidosis
Preparation of Equipment
First prepare the equipment follow by

Intubation:
Requirements: Present in E-Cart:
Pneumothorax
cardiac monitor
pulse oximeter
laryngoscope (check light)
Cardiac Arrest
Adult blades No. 3 & No. 4
Magill forceps
lubricant
connector- Bodi Y / elbow (may be
Respiratory Failure
required)
Flexible introducer
Syringe 10 ml
RAPID SEQUENCE INTUBATION (RSI)
Clamp
Guedel airway Nos. 2 or 3
RSI is a method of intubating patients
Tape for ties
who have a gag reflex otherwise be difficult to
licorice stick
intubate. Intubation is accomplished by
sedating and the patient, allowing for easier
Endotracheal tubes: usually 8 mm for
intubation.
women; 9 mm for men ; age/4 + 4 for
children. e.g. age 8 - a 6 mm tube
Means of inflating lungs - Air Viva,
anaesthetic machine
Indications or candidates for RSI?
With face mask: size 3 for women; size
4 for men
1. Head injuries and respiratory exhaustion.
Suction apparatus with Yankauer
nozzle and endotracheal suction
2. Certain overdoses, facial injuries, and burns
catheter
3. CVAs Very careful attention should be paid
Receptacle - dirty dish for used
to the patient in CHF.
laryngoscope, face mask.
4. Failure of airway
5. Failure of oxygenation/ventilation
REASON FOR RSI-PROCEDURE
1. Protection from gastric aspiration and

secretions
2. For Oxygenation-
Steps in RSI:
The 9 Ps of RSI
c. If systolic pressure is 80-100 mmHg,

utilize etomidate or decrease midazolam
1.
dose.
Prepare:
5. Protection /Positioning
-IV
-O2: nasal cannula /face
mask
-Cardiac Monitor
-Equipment:
Laryngoscope and blade w/
functioning light
after giving meds or agent, apply

Sellick manuever, firm pressure on
cricoid cartilage to prevent regurgitation
and prevent aspiration of vomittus into
lungs
6. Pass the tube

7. Placement of proof;
-intubation,
Endotracheal tube
8. Post-intubation
Stylet
-Medication ready
Management: secure the tube/ventilate

9. Patient concerned/ pts care.
-Personnel
Chest Drainage Chest Tube Insertion
Surgical insertion of a hollow, flexible
drainage tube into the chest. .
2. Pre-oxygenate with 100% oxygen
-nasal cannula/ face mask
the patients condition and the doctor

s judgment.
-Bag mask ventilation if necessary

3. Pre-treatment
-Lidocaine: 1.5 mg/kg to patients with
head trauma or stroke. it dec.
bronchospasm and dec. ICP.
4. Paralysis w/ induction:
a. Midazolam dose is 2 mg for the
average size adult.
b. Etomidate dose is 0.3 mg/kg, about
20 mg for the average size adult.
The insertion site varies depending on
Chest Tube Insertion - Series:

Indication:
air leaks from the lung into the chest

(pneumothorax)
bleeding into the chest (hemothorax)
after surgery or trauma in the chest
Minor set
Two pairs of sterile gloves /
(pneumothorax or hemothorax)
lung abscesses or pus in the chest

(empyema).
For Pneumothorax
The second to third intercostal spaces
are the usual sites because air rises to the top
of the intrapleural space.
sterile drapes
1% or 2% lidocaine / cb w/
betadine or antiseptic sol.
10ml or 5ml syringe with
needle gauge 23-26

For Hemothorax or pleural effusion
The fourth to sixth intercostal space are
common sites because fluids settles to the
lower levels of the intrapleural space.
Scalpel # 11 with blade 20 / 15
Sterile Kelly clamp, needle
holder, tissue forcep w/ teeth,

Preparation of CCT insertion equipment
Check the expiration date of
the sterile packages and inspect for

tears.
Assemble the equipment
Set up the thoracic drainage
system
Place the thoracic drainage
system next to the pts bed below

chest level to facilitate drainage.
PROCEDURE / EQUIPMENT In chest tube
insertion
OS 4x4, adhesive tape and
connection
Chest tube ( trocar Size : for
French # 16, 20 indicated for air and

serous fluid / French # 28, 40 for
blood, pus and thick fluid.
Suture materials silk 2-0 with
cutting needle
Thoracic drainage with tubing /
sterile and a connector
Petroleum gauze / sterile water
Implementation
Confirmation:
Informed consent
Explain the procedure, provide
privacy and hand washing practice.
Check for the order
Prepare for the equipment :
Obtain chest x-ray for confirmation:
Position encourage coughing and deep

breathing exercises.
Record V/S before-after the
procedure
tube inserted in the anterior

chest @ midclavicular line in
the 2nd to 3rd ICS
Hemothorax = lean over bed table or

straddle a chair with his arms dangling
over the back (Orthopneic
position/high fowlers position). Tube
inserted in the 4th to 6th ICS midaxillary
line.
A stitch (suture) and adhesive
Allow to observe the pt for signs of

resp. distress indication that air or fluid
remains trapped in the pleural space.
Position:
Pneumothorax = high fowler
Special Consideration
Accidentally out: cover the site

immediately with gauze pad with
paraffin and tape them in place.
Observe for s/s of tension

pneumothorax if hypotension, DJV,
absent or dec. breath sounds, tracheal
shift, rapid pulse, dyspnea, diaphoresis
and chest pain.
Continuous bubbling noted.
tape is used to keep the tube in place.
X-rays if the lung has fully re- Chest Tube Insertion - Series: Aftercare
The patient will stay in the hospital until the
expanded also shows that all blood,
chest tube is removed. While the chest tube is
fluid or air has drained for the chest. in place, the nursing staff will carefully check
for possible air leaks, breathing difficulties,
and need for additional oxygen..
Chest Removal

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Respiratory-Airway and Ventilatory

A 48yo male pt w/ status asthmaticus has just

is characterized by an acute episode of

10% of this case require tx in an ICU

Pathophysiology: Involves decreased

o Signs and symptoms

Ineffective management of therapeutic

Deminished breath sounds

Goals of Collaborative Management:

Nursing Diagnosis-actual potentials

Ineffective breathing pattern.

Ineffective airway clearance.

Risk for infection

Dx & Lab. Test

Pulmonary function test

Position: high fowlers

Adm humidified low-flow O2 via

venturi mask or nasal cannula

Care for: IV, Meds, Intubation,

Health teaching plan during

3. Secretions- facilitates removal of secretions

First prepare the equipment follow by

1. Protection from gastric aspiration and

c. If systolic pressure is 80-100 mmHg,

Laryngoscope and blade w/

after giving meds or agent, apply

6. Pass the tube

Management: secure the tube/ventilate

the patients condition and the doctor

-Bag mask ventilation if necessary

The insertion site varies depending on

Chest Tube Insertion - Series:

air leaks from the lung into the chest

bleeding into the chest (hemothorax)

after surgery or trauma in the chest

Two pairs of sterile gloves /

lung abscesses or pus in the chest

betadine or antiseptic sol.

10ml or 5ml syringe with

needle gauge 23-26

Scalpel # 11 with blade 20 / 15

Sterile Kelly clamp, needle

holder, tissue forcep w/ teeth,

Check the expiration date of

the sterile packages and inspect for

Assemble the equipment

Set up the thoracic drainage

Place the thoracic drainage

system next to the pts bed below

OS 4x4, adhesive tape and

Chest tube ( trocar Size : for

French # 16, 20 indicated for air and

Suture materials silk 2-0 with

Thoracic drainage with tubing /

sterile and a connector

Petroleum gauze / sterile water

Explain the procedure, provide

privacy and hand washing practice.