12/14/15 Morning Report

MKSAP Question: Understand the difference between between dehydration and hypovolemia – dehydration is defined as loss of free water.

Thanks to Fernando for presenting an interesting case!

Teaching Pearls:

  • Asthma affects approximately 5% of the population.
  • Commonly present in adolescent/young adults, but can also present in the elderly.
  • Risk Factors for Asthma Exacerbations: 1) Prior Intubations 2) # of Hospitalizations in Last Year 3) Not on inhaled corticosteroids or PO steroids 4) Tobacco/Polysubstance Abuse 5) Psychosocial Issues 6) Non-compliance 7) Multiple Medical Co-morbidities
  • PFTs will demonstrate obstructive airway disease with FEV1/FVC <70%. With bronchodilators, reversibility will be seen.
    • FEV1 improvement of 12% with total change >200cc demonstrates reversibility.
    • TLC will be elevated.
    • DLCO should be normal (Watch out for any false positive and false negative results)
  • Antibiotics are not routinely recommended in patients with asthma exacerbation in the absence of a consolidation.
  • Beware of a “normal” pCO2 in a patient who is hyperventilating and admitted with asthma exacerbation.
  • Treatment of Asthma Exacerbation: Steroids, Short Acting Beta Agonists +/- anticholinergic medications. Needs continual reassessment.

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