Dynamic hyperinflation (autoPEEP, air trapping, etc.) is a process leading to an increase in end-expiratory lung volumes and increased airway pressures. This process may occur secondary to obstructive lung pathology and/or an increase in minute-ventilation without sufficient time for expiration. The pathologic effects of dynamic hyperinflation include an increased work-of-breathing, barotrauma, pneumothorax, and an increase in intrathoracic pressure leading to a decrease in cardiac output and possible hemodynamic collapse. Rapid identification of this process is crucial for reversing it.

In the setting of a severe asthma exacerbation that is refractory to medical mangagment and noninvasive ventilation, mechanical ventilation can be life-saving. However, the ventilator can quickly kill your patient if careful thought is not taken to address the unique respiratory needs and pulmonary physiology inherent to severe asthma.

The mild, moderate, or severe asthma exacerbation is cemented in the practice of Emergency Medicine. As a provider of this great speciality, one should be intimately familiar with the range of therapies employed. The goal of this post is to provide a high-yield review of the therapies we use (or sometimes use) while treating these patients.

Extracorpreal membrane oxygenation is a temporizing mechanical support to heart or lung function in the setting of cardiopulmonary failure. In the setting of severe respiratory failure, patients that may benefit from and/or have an indication for ECMO are described in the Extracorporeal Life Support Organization Respiratory Failure Supplement to ESLO General Guideline, December 2013:

Indications:

A high-yield review of the past week on EMDaily

Planning your next trip to the Rocky Mountains? Treating patients on base camp of Mount Everest? Here are the high-yield basics of High Altitude Illness including Acute Mountain Sickness, High Altitude Cerebral Edema (HACE), and High Altitude Pulmonary Edema (HAPE).