in emergency room ,
when pt dyspnic , wheezy chest , known case of asthma , and after excluding other causes like heart failure , we should decide if it simple attack resolved with inhaler at home or this acute severe asthma
if hr>110 , rr >25 , cant complete single sentence in one breath
start o2 100% , ventolin 5mg and ipratropium bromide (atrovent nebulizer 0.5mg ) mixed and given every 20min 3times
prednisolone tab 50mg or hydrocortisone 2vials
while giving those drug mentioned above , now search for life threatening asthma such spo2 92% ,hypotension ,silent chest , gcs <15 , cyanosis , not responding to the first line treatment
presence of one of these symptoms , send x ray to exclude pneumothorax , ABG for pco2 to see if normal or high (if there respiratory failure ) , and give mg sulphate (2g in 100cc n/s in 30min (70 drop/min) and call permanent