You are sitting at home and are increasingly aware that you asthma is getting worse. You reach for your fast acting breathing inhaler and it is not helping. Your respiratory rate is increasing and you are using more chest muscles to breath. You are finding it difficult to talk and walk. This is the point where you should have already sought treatment in the nearest ER. Asthma can lead to a respiratory arrest where you stop breathing and it can lead to death. Asthma is something that you cannot choose to ignore ignore because it could cost you your life.
When you arrive in the ER, the RN will perform an initial assessment. They will take your vital signs, which includes your heart rate, your respiratory rate and oxygen saturation. They will use a peak flow meter which measures air flow by having you blow into the meter. This will give a picture of how open your airways are. Your peak flow reading drops as your asthma gets worse. Any asthma patient can usually tell you what their good peak flow range is and what number tells them they are in trouble.
An asthma attack is where the airways are swollen and become irritated and air has difficulty getting in and out of your lungs. Asthma attacks often occur in response to what is known as triggers. Some examples of triggers are smoke, pet dander, mold and mildew, stress, cold air, viral infections, dust mites and exercise.
When you are having a asthma attack the ER will focus on your respiratory status. The will do a lung auscultation where they place a stethoscope over your lung fields and listen for air movement. They will do a physical assessment to see if you are using accessory muscles to breath and they will order a chest XRay. If you are having significant breathing problems and you oxygen saturation is dropping, they will do an arterial blood gas and which shows your PH of your blood and carbon dioxide and oxygen levels.
Usually they will start out by giving you a medication known as a short acting beta agonist ( Nebulized Albuterol ). You will receive a dose every 20 minutes for a period of one hour. They may add a medication known as an anticholinergic to the nebulized albuterol. Your will be placed on a continuous pulse ox to monitor you oxygen saturation.While all this is going on you will have an IV started and will receive a dose of IV corticosteroids. You will have frequent respiratory status assessments done and if you do not show improvement in a few hours you can plan on being admitted to the hospital.
If your asthma has advanced to a state where the air exchange in your lungs is getting less and you are requiring more advanced forms of delivering oxygen to your lungs, you may end up in the ICU (intensive care unit). A t this point your respiratory rate be greater than 30 breaths a minute, your heart rate will be increasing, your oxygen saturation will be dropping and your CO2 (carbon dioxide) is rising .This is the point where they may make a decision to place you on life support ( Breathing machine known as a ventilator ).
All patients are taught at discharge information on managing their asthma attacks and how to try to prevent further attacks. Any ER nurse will tell you that asthma attacks are one of the most frequent reasons for coming to the ER. They will focus on having you try to eliminate triggers that cause asthma. Avoiding smokers, staying away from animals like cats if you are allergic to them, staying away from sick people especially those with respiratory illnesses will be strongly encouraged. The RN will enforce the importance of taking your asthma medication, because missing you asthma medications can bring you right back to the ER. You will be taught to recognize and treat your symptoms early by using your inhaler medication which is also known as a rescue medication. Following your medication regime and avoiding triggers can keep you out of the Emergency department.