Summer listed warning signs which can identify a patient with status asthmaticus who is at risk of dying. These can help to identify a patient who may benefit from more aggressive management. The author is from LSU Medical Center in New Orleans.


Warning signs:

(1) previous or recurrent episodes of status asthmaticus

(2) previous intubation for status asthmaticus

(3) FVC < 1.0 liters; FEV1 < 0.5 L; PEFR < 100 L/min

(4) poor response to bronchodilator therapy, with change in FEV1 < 400 mL or change in PEFR < 60 mL per minute (3.6 L per hour) at 1 hour after therapy

(5) altered level of consciousness

(6) hypoxemias (PaO2 < 50 mm Hg) with central cyanosis

(7) hypercapnia with PaCO2 > 45 mm Hg

(8) pulsus paraodoxicus

(9) ECG abnormalities

(10) occurrence of pneumothorax or pneumomediastinum


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