Treatment of asthma exacerbation which is not - harry206

[ArchivalUser]

responding to albuterol, ipratropium and steroids.

[ArchivalUser]

what do you mean?

[ArchivalUser]

Ans:
- magnesium sulphate 2 gm IV over 10 min, or
- Heliox (helium/oxygen mixture)

[ArchivalUser]

why do you want to give magnesium?

[ArchivalUser]

For severe asthma exacerbations, intravenous magnesium sulfate has been shown to be beneficial. The usual dose is 2 g over 20 minutes; the effect of higher and faster doses is uncertain. These larger doses have demonstrated safety for almost 50 years in the obstetrics literature, with rates as high as 1 g/min for 3 g. Intravenous magnesium sulfate has little (if any) value in mild-to-moderate exacerbations and should not be used in that setting.

[ArchivalUser]

Heliox is a helium-oxygen (80:20 or 70:30) mixture that may provide dramatic benefit for ED patients with severe exacerbations.
Helium is about 25% as dense as room air and, consequently, it travels more easily down narrowed passages. This property makes heliox of particular value to patients at risk of intubation”by quickly decreasing the work of breathing and, when the gas mixture is used to drive the nebulizer, by better delivery of the inhaled bronchodilator.
Despite considerable promise, the literature shows mixed results. Potential explanations include the large number of small trials (low statistical power) and suboptimal delivery of albuterol to the patient. Briefly, heliox-driven nebulizer treatments should have the gas set at a rate of 8-10 L/min and with double the usual amount of albuterol. These adjustments result in the delivery of the appropriate amount of albuterol to the patient but with particles being delivered in the heliox mixture instead of oxygen or room air. When patients need supplemental oxygen, one can deliver it via nasal prong. Of course, as the supplemental oxygen is increased, the benefits of using heliox decrease. Oxygen requirements should determine the ideal mix. The role of heliox in acute asthma remains under investigation