Internal illnesses. Status asthmaticus (complication of severe bronchial asthma) (lecture notes)

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Internal illnesses. Status asthmaticus (complication of severe bronchial asthma) (lecture notes)

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LECTURE No. 30. Asthmatic status (complication of severe bronchial asthma)

Etiology. The reasons for the status may be resistance to sympathomimetics and other bronchodilators, rapidly developing total pulmonary obstruction, the development of hypoxia and hypercapnia.

Clinic. There are 3 stages of flow.

At stage 1, there is a discrepancy between distant noises (there are many of them, they are more intense) and auscultatory data (a small amount of scattered dry rales, breathing is weakened), tachycardia, a tendency to increase pressure, resistance to cardiac glycosides, accent and splitting of the II tone over the pulmonary artery, anxiety, tension, asthenia, pale cyanosis.

In stage 2, respiratory failure, tachypnea, oligopnea increase, the sonority and number of dry rales decrease, their disappearance is possible, the formation of a "silent" lung, hypotension, decompensated respiratory acidosis and hypercapnia.

In stage 3, there is pronounced diffuse cyanosis, loss of consciousness with the participation of all reflexes, "silent" lung syndrome, frequent and small pulse, sonorous heart sounds, hypotension, collapse, hypoxic coma is formed.

Treatment. Treatment consists in the rejection of β2-agonists, glucocorticoids (up to 1500 mg per day of prednisone) are administered parenterally and orally, rehydration therapy is performed (up to 3 liters of fluid per day), epidural anesthesia, artificial ventilation of the lungs with bronchoalveolar therapeutic lavage.

Author: Myshkina A.A.

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