Mel Herbrert presents a case and hosts a discussion on the worst asthma exacerbations, with our expert EMA panel Rick Bukata, Jerry Hoffman, and Ramin Tabatabai.

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Ian L., Dr -

The anaesthetic bronchodilator Sevoflurane is described as beneficial by Schutte D et al Br JAnaesthesis 2014 Dec 967-970.
Rusk au Z describes a case report of benefit outside the Emergency Room using Sevoflurane with an anaesthetic Conserving Device in Can J Anaesthesia Oct 943-950On November 21 in 2016 in Melbourne Australia there was an Asthma Storm Weather event :8500 persons sought treatment and there were nine deaths .
Ambulances attended in large numbers.
Epinephrine s/c or some say better IM ought to have helped as temporising treatment at a minimum with inhaled continuous albuterol .
Epinephrine can be given every five minutes for three doses I believe .
What does the Panel surmise .?

Mel H. -

Anesthetic agents generally not available in the ED obviously. We don't have the machines, the scavengers and knowledge - but it is very much an option to add in some ICU's. Thanks for the reference I will pull that paper - sounds like a total asthma explosion!! Crazy!

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