Professional Documents
Culture Documents
Triage - ARDS (Autosaved)
Triage - ARDS (Autosaved)
Emergency
Marshell Tendean, MD DPCP
Department of Intenal Medicine
UKRIDA Jakarta
Objective :
Emergency
P priority
Q Queue (non urgent)
Emergency Case :
Emergency
Urgent
False emergency
Death
Surgery
Approach to patients in Emergency situation
Untreated or undertreated comorbidities such as chronic rhinosinusitis, reflux disease or obstructive sleep apnoea syndrome.
The term severe refractory asthma should be reserved for patients with asthma in whom alternative
diagnoses have been excluded, comorbidities have been treated, trigger factors have been removed (if
possible) and compliance with treatment has been checked, but still have poor asthma control or frequent
(>2) severe exacerbations per year despite the prescription of high-intensity treatment.
Natural history and risk factors
The severe asthma phenotypes are related to genetic factors, age of asthma
onset, disease duration, exacerbations, sinus disease and inflammatory
characteristics
Early childhood-onset asthma (over a range of severity) is characterized by allergic
sensitization, a strong family history and more recently, non-allergy/atopy related
genetic factors.
Late-onset, often severe asthma is associated with female gender, reduced pulmonary
function despite shorter disease duration, and in some subgroups, a strong association
with persistent eosinophilic inflammation, nasal polyps and sinusitis and often aspirin
sensitivity and respiratory tract infections, but less support for specific genetic factors.
Pathogenesis :
Obesity
Hyperventilation syndrome
Drugs: Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), -adrenergic blockers, angiotensin converting enzyme inhibitors
(ACE-inhibitors)
Condition mimicking severe asthma.
Step 3. Approaches to Asthma Phenotyping
Step 4. Therapy
Established therapies
NIPV
Intubation
Pneumothorax
Pneumomediastinum
Subcutaneous emphysema
Pneumopericardium
Myocardial infarction
Mucus plugging
Atelectasis
Theophylline toxicity
Electrolyte disturbances (hypokalemia, hypophosphatemia, hypomagnesemia)
Myopathy
Lactic acidosis
Anoxic brain injury
Acute Respiratory
Distress Syndrome
ARDS
Definition :
An Acute onset; ratio of partial pressure of arterial oxygen to frac tion of
inspired oxygen (PaO2/FiO2) of 200 or less, regardless of positive end
expiratory pressure; bilateral in ltrates seen on fron tal chest radiograph;
and pulmonary artery wedge pressure of 18 mm Hg or less when measured,
or no clinical evidence of left atrial hypertension.
But in my missery