The EM Educator Series: The Sick Adult Asthma Patient

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!


Case #1:

A 48-year-old male presents with diffuse wheezes and elevated respiratory rate.  He is in respiratory distress. His wife says he has a history of severe asthma, and he has not been able to utilize his controller medications in the last week.

Case #2:

A 29-year-old female comes in with somnolence and decreased air movement bilaterally. Per EMS, she has a history of severe asthma. Her end tidal CO2 is markedly elevated.



  • What conditions can mimic asthma?
  • What are red flags in the history and exam for severe asthma, as well as mimics?
  • What other medications should you consider beyond nebulizers and steroids? What place do magnesium, ketamine, and epinephrine have?
  • Is NIPPV effective for respiratory distress in asthma?
  • How can ultrasound help?
  • While you try to avoid it if possible, how do you optimize intubation?
  • What ventilator settings should you use after intubation? What is permissive hypercapnia?
  • What should you consider and what can you do when the patient crashes after intubation?


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