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- Even under the best of circumstances, people who have asthma are always at risk for a bad attack. So, here we talk about short-term treatments. So, I'm going to write asthma attack, and this level of symptoms will usually land this person in the hospital. So, this is what we would do in the short-term to get them out of that. Hopefully, when the symptoms first started they would have tried the things that usually work for them. They should have tried their rescue inhaler with usually it's a beta-2 agonist. Beta-2 inhaler didn't work. They could try a nebulizer. Nebulizer. Or they could try something with a steroid. Usually, if they're having a really severe attack, the things they usually do for themselves won't be helpful. Hopefully, in route to the hospital they would have been given some oxygen. Since their lungs are really struggling to get air in, they need some help staying oxygenated. So, oxygen should be given freely to people who have asthma attacks. Okay, so now we're at the hospital, and so far, nothing has helped this person. We basically can take some of the same drugs that you would use at home and upgrade them to the big guns, by making them IV or intravenous. I'm sure you've all had this before. When you got to the hospital, they put a needle with a catheter behind it into your arm, could be your leg, depending on what's most convenient, and the drug gets infused directly into the bloodstream. So, the closer a medicine gets to our blood during the delivery, the more pure it is. So, inhaled or ingested or a pill or something, it takes a while to get there, but directly into our blood, it's going to be fast. So, we can do some of the same things. So, beta-2 or we can do IV steroids. This is really the big guns. We can also do magnesium sulfate, which is just a chemical that also opens up the smooth muscles in our lungs, force it open, and help the patient breathe better. Something else we can give is epinephrine or I'm just going to write epi. You've probably heard of people who have bad allergy reactions and carry an EpiPen. This is sort of the same thing. So, epinephrine in our body is usually produced by the adrenal glands, and epinephrine starts the whole fight or flight emergency response, and it has effects all over the body. So, it can get our eyes to open up, so we can see better during the attack. It can make our heart beat faster, pump more blood to the muscles, and in the lungs, it opens up the airways. So, this person is going to get heart palpitations and just feel really panicked, but that's the side effect, because the epinephrine may save their life by opening up their lungs. Epinephrine can be given as an injection, and we usually only give a little bit at a time. So, epinephrine here. At this level, instead of giving them just steady oxygen, a few liters through their nose, we might upgrade to masks. They can either be called CPAP or BiPAP. The difference between these two is how continuous the pressure is. The main thing to remember with these is that they both push oxygen into the lungs, just with greater force than you would get with a nasal cannula or just tubes in the nose. So, this CPAP or BiPAP covers their face and forcefully pushes oxygen in to help them oxygenate better. At this point, if none of this have worked for this patient, then we've got to think about intubation. Now, intubation is kind of a big procedure. We're going to put a breathing tube down their throat and hook it up to a machine that mechanically breathes for this patient, and, of course, that's very uncomfortable, so we have to knock them out with some drugs. I'm going to draw a breathing tube here. So, this can be a big procedure for some people, because they have to be under anesthesia, and intubation itself is hard on the lungs, but as a last resort, it's necessary to save people's lives. It can be a hard call of when it's time to intubate. If you intubate too late, they might have permanent damage from lack of oxygen, or too early, it can hurt the lungs and put them through something unnecessary. So, at these levels there's a question mark of when to go to this step, but when it's necessary and this person is just not responding to treatment, it's definitely necessary for a bad asthma attack. But hopefully, our asthma patient knows the things that trigger them and avoid them. So, I would say this every time, avoid smoking, either secondhand or firsthand. Avoid NSAIDs. This is your ibuprofen, your aspirin, a lot of painkillers. This can trigger in a lot of people, especially adults. Avoid things like allergens, and basically just avoid the triggers. The key is to know yourself and know what triggers you and stay away from those things. And for our patient here, if they've gotten to this level, definitely if they've gotten to intubation, they'll probably need to stay in the hospital for a while, to make sure they don't have another attack and to make sure that they recover from this one.