Evaluation-asthma-EXACERBATION

• History: baseline PEF, steroid requirement, ED visits, hospital admissions, prior intubation

Current exacerbation: duration, severity, potential precipitants, meds used

Risk factors for life-threatening: prior intubation, h/o near-fatal asthma, ED visit/hosp for asthma w/in 1 y, current/recent PO steroids, not using ICS, overdependent on SABA, Ψ, h/o noncompliance

• Physical exam: VS, pulm, accessory muscle use, pulsus paradoxus, abdominal paradox

Assess for barotrauma: asymmetric breath sounds, tracheal deviation, subcutaneous air → pneumothorax, precordial (Hamman’s) crunch → pneumomediastinum

• Diagnostic studies: peak expiratory flow (know personal best; <80% personal best c/w poor control, <50% c/w severe exacerbation); SaO2; CXR to r/o PNA or PTX; ABG if severe (low PaCO2 initially; nl or high PaCO2 may signify tiring)