Adult Medical Emergency Handbook - Scottish Intensive Care Society

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• Check peak flow and compare to predicted or previous best PEF:
may be too ill to do this.
PaCO 2 PaO 2 [H + ] SEVERITY
Low Low Low Moderate
Normal Low Normal Severe
High Low High Life-threatening
Immediately contact Respiratory Registrar/Consultant and alert
ICU if ABGs indicate life-threatening attack.
• Salbutamol 5mg nebulised in oxygen 8l/minute, repeated every
10-15 mins if necessary.
• Add nebulised ipratropium 500 micrograms (4-6 hourly) to
salbutamol for patients with acute severe or life-threatening
asthma or those with a poor initial response to salbutamol.
• Prednisolone 40mg orally or
• Hydrocortisone succinate 200mg IV (slowly) if unable to take
orally.
• If no response to repeated nebulised bronchodilators, Respiratory/
Medical Registrar or ICU staff could consider IV magnesium
sulphate 2.0g over 20 minutes or IV aminophylline 250mg
(maximum 5mg/kg) by controlled infusion over 20 mins followed by
a continuous infusion.
Do not use aminophylline without the advice of Respiratory or
Intensive Care specialists.
Do not give loading dose of aminophylline to patients on oral
therapy. Check the theophylline blood concentration.
Caution: Magnesium is a powerful vasodilator and may cause
dangerous hypotension in the hypovolaemic or septic patient.
• Chest x-ray - all severely ill patients. Urgent if clinical signs
suggest pneumothorax.
• Calm reassurance throughout is highly beneficial.
• U&Es, FBC, 12 lead ECG should be performed.
Clinical Improvement
• Less distressed.
ASSESSMENT OF RESPONSE
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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