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Old 10-30-2012
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Arrow Gyrus Daily Questions; Internal Medicine #59

A 47 year old man with a history of asthma comes to the emergency department with several days of increasing shortness of breath, cough and sputum production. On physical examination his respiratory rate is 34 per minute.He has diffuse expiatory wheezing and a prolonged exploratory phase.

Which of the following would you use as the best indication of the severity of his asthma?

a. Respiratory rate.
b. Use of accessory muscle.
c. Pulse oximetry.
d. Pulmonary funciton testing
e. Pulse rate
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Should be respiratory rate
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I would Use ABG, with a close observation to PCO2, but clinically the closest correlation to PCO2 = ventilation and that equals respiratory rate.

If the respiratory rate starts to decrease then that means the PCO2 will start to "normalize" and therefore that would mean the patient is crashing.

not sure about the answer tho.
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The best way to assess the severity is the peak expiratory flow (PEF) which can also be a part of spirometry but best indicator of the severity is RR.


Quote:
The peak expiratory flow (PEF), also called peak expiratory flow rate (PEFR) is a person's maximum speed of expiration, as measured with a peak flow meter, a small, hand-held device used to monitor a person's ability to breathe out air. It measures the airflow through the bronchi and thus the degree of obstruction in the airways.
Another very high yield point:
Quote:
When putting an asthmatic on a ventilator, use a low rate, small tidal volume, and high flows. Each of these addresses the need for a prolonged expiratory phase High flow on the inspiration allows for less time devoted to inspiration and more to expiration
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Last edited by Novobiocin; 10-30-2012 at 05:44 PM.
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Quote:
Originally Posted by XpaezX View Post
not sure about the answer tho.
Where is your MTB 2 page 132 ?
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Quote:
Originally Posted by Novobiocin View Post
Where is your MTB 2 page 132 ?
Yup there it says that! apparently I answered correctly but I used another logic, I remembered the other questions always making us to look at the "normalization" of PCO2 in the ABG, I remembered from step 1 that PCO2 is related to ventilation and not "respiration; which is actual gas exchange" and correlated that with the formula for minute ventilation = Respiratory rate + Tidal volume and then answered according to my weird logic
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Quote:
Originally Posted by XpaezX View Post
Yup there it says that! apparently I answered correctly but I used another logic, I remembered the other questions always making us to look at the "normalization" of PCO2 in the ABG, I remembered from step 1 that PCO2 is related to ventilation and not "respiration; which is actual gas exchange" and correlated that with the formula for minute ventilation = Respiratory rate + Tidal volume and then answered according to my weird logic
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Yes so answer ...U all know its A. Respiratoy rate.

just for confirmation

Severity of asthma exacerbation is quantified by.

Decreased PEF
ABG with an increased A-a gradient.
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