Asthma Exacerbation Case Study 1 - Treatment (Asthma Flare / Attack)

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MedCram - Medical Lectures Explained CLEARLY

MedCram - Medical Lectures Explained CLEARLY

2 жыл бұрын

Acute asthma exacerbation treatment with illustrations by pulmonologist Dr. Seheult. See all Dr. Seheult's videos at: www.medcram.com/?Y...
(This video was updated on August 10, 2022)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.com/?Y...
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
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#asthma #ventilation #casestudy

Пікірлер: 105
@Medcram
@Medcram 2 жыл бұрын
Go to medcram.com for more videos on medical topics including continuing medical education units.
@musieberihune1723
@musieberihune1723 2 жыл бұрын
Sir no words to say .Thank you you are teaching us (physicians ) residing in rural Africa. I feel very much lucky to get this
@diane0402
@diane0402 2 жыл бұрын
I was diagnosed with asthma at age 8. I used many meds over the years including theophylline, albuterol, flovent, advair ,etc. it was well controlled and I was never hospitalized. If I stopped taking my meds, I'd have the typical tightness, cough, mucus. I started the keto diet about 5 years ago and my asthma has gone away....totally away. I am 49 now and don't take meds. I have no flares or issues. Docs need to start looking closer at food allergies and recommending new ways, other than meds to control, and possibly cure, this debilitating disease.
@joebarcelona
@joebarcelona 2 жыл бұрын
Thank you for sharing that experience.
@flagmichael
@flagmichael 2 жыл бұрын
Asthma seems to be almost as slippery as it was a couple generations ago when our family went mano a mano with it. In our case the big allergen was mold... and that was in Phoenix. I'm glad you are med and flare free! Our son estimates he will live into his 50s, and my retired nurse wife and I sadly agree. Lots of damage from prednisone but it kept him alive.
@Idiotsincarshere
@Idiotsincarshere 2 жыл бұрын
I mean that's good for you but we need some RCTs to test your belief that keto cures asthma. I'd rather have asthma than to do keto, but that's me. Fun fact, we have largely prevented many asthma related hospital admissions and most deaths with the use of inhaled corticosteroids and bronchodilators. Not so much for keto. Yay science!
@MarkShinnick
@MarkShinnick 2 жыл бұрын
Yes, It's fascinating... persons come for MEDICAL treatment.....but really need diet care.
@jsmith71251
@jsmith71251 2 жыл бұрын
YES! THIS IS MY STORY ALSO! people think I'm crazy when I tell them. I can remember running out of albuterol inhalers and paying people to go to the emergency room for me. Buying them from people on the street. Now like you I'm cured! And I'm also 49. 50 next month. Would love someone to create a group for people like us to talk. When I tell people I swear they say I'm lying, or that my asthma was faked all these years. I don't talk about it anymore. I feel vindicated. Thank you!
@rajnbull
@rajnbull 2 жыл бұрын
this is exactly the problem I have from 9/11 as a paramedic
@Aa-ji2yf
@Aa-ji2yf 2 жыл бұрын
Love this. Thank you so much for teaching us.
@flagmichael
@flagmichael 2 жыл бұрын
One of our sons was diagnosed with moderately severe asthma as a young child. He was prednisone dependent from age 6 to age 13, which has caused serious lifelong problems. Do not underestimate the dangers of poorly controlled asthma! He spent 3 months in National Jewish Hospital, finally resulting in being prednisone free except for flares; his daily medications dropped from 17 to three. (His hometown allergist knew many of them were not helping but he was too brittle to try backing any of them off in an outpatient setting. It was there, in family education, that they introduced the concept of an "allergy bucket." We may not show identifiable symptoms from air pollution, pollens, or whatever but they all go in the bucket. When the bucket is full asthma symptoms appear. That has been one of the most useful learnings we took back from the education. Obviously, the technical side of this presentation does not guide our treatment protocol (he is living with us because of the extensive prednisone damage) but it gives us more information and that is never a bad thing.
@RICDirector
@RICDirector 2 жыл бұрын
The bucket makes sense, actually, at least for me. Thanks!
@AbacusincInfo
@AbacusincInfo 2 жыл бұрын
Dr. S., Thank you! With a new baby she probably isn't getting enough sleep, fluids or sunlight. Glad you saved her life. If she is breastfeeding she might be limiting her meds. I try to avoid albuterol but sometimes need it. I have bad side effects. I try menthol cough drops, coffee, theobromine, vitamin c, magnesium and bromlain daily to keep from needing the inhaler. I also sometimes place a heating pad on my chest. This seems to abate it. It is a horrible condition to have and it is so exhausting. Also, noticed that with exercise induced asthma you need to try to exercise despite it.
@granitabirg7950
@granitabirg7950 2 жыл бұрын
Thank you so much for sharing.🙏🙏
@helenel4126
@helenel4126 2 жыл бұрын
I watched this video with great interest. I've had asthma since I was three. Any cold exacerbates my asthma. (Unfortunately, I typically need a week's course of prednisone to recover.) I'm very fortunate to be under the care of an excellent pulmonologist. A decade ago, I suffered from the flu (despite having received the inoculation for that year). The hospital attempted to place me on a breathing device that pumped air into me while I was conscious. Thank goodness, when I spat the hose out (almost immediately) the nurses didn't shove the thing in and sedate me. I fear the incompetence of staff almost as much as I do catching a cold. (And yes, I was a guinea pig for a certain pharma company's v study, because I wanted to be as protected as possible as quickly as possible - not that such seems, in retrospect, to be much of a safeguard)
@deborahhebblethwaite1865
@deborahhebblethwaite1865 2 жыл бұрын
Thanks Dr S🇨🇦
@Belloney10
@Belloney10 2 жыл бұрын
You're an amazing teacher, thank you
@scottslotterbeck3796
@scottslotterbeck3796 2 жыл бұрын
He has a gift for teaching
@tonniettecisneros8046
@tonniettecisneros8046 2 жыл бұрын
Thank you for explaining asthma...I am a severe asthmatic and have been intubated 10+time and in ICU more times than I can remember. Most persons have no understanding of the problem ...that we can not empty our lungs. Due to repeated i tubation I also have V.C.D,vocal cord dysfunction so my attacks start in both the throat and lungs. I am seen by a renowned Pulmonologist but remain uncontrolled. Please continue to educate others
@americanpaisareturns9051
@americanpaisareturns9051 2 жыл бұрын
Fascinating
@alexagaxi
@alexagaxi 2 жыл бұрын
That makes so much sense wow, thank you
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
Such a great explanation. My wife's asthma crises are more understandable now. I sent my wife a link and she appreciated it. She sees her pulmonologist every three or four months.
@badwagon7799
@badwagon7799 2 жыл бұрын
Life long Asthmatic and the only Doctor that did any good for me retired several years ago. Can you please list the diff.meds you spoke of so I can try to talk to a new doctor about getting these on my maintenance scripts? Thank you.
@readwriter
@readwriter 2 жыл бұрын
Is this information generalizable to the twice-daily exacerbations that occur with chronic bronchitis / bronchiectasis?
@joyfisher8008
@joyfisher8008 2 жыл бұрын
I'll have to look for your videos about how to PREVENT getting into the situation where the ventilator is needed! As 1 comment below points out there are many items that combine into an individual's "allergy/asthma bucket"
@sapelesteve
@sapelesteve 2 жыл бұрын
Very interesting case study Doc! I am going to assume that the patient responded well to treatment and was released from the hospital. I hope that you do a follow up on this case. Thanks and hope that all is well with you! 👍👍
@Medcram
@Medcram 2 жыл бұрын
Yes. Concluding video to be released soon
@RICDirector
@RICDirector 2 жыл бұрын
So...are smooth muscle relaxants used to help ease constriction? (Sorry if this is a silly question...)
@bobcocampo
@bobcocampo 2 жыл бұрын
Can nitrates help asthma?
@richardgulan784
@richardgulan784 2 жыл бұрын
Is she on a maintenance inhaler?
@sherlynmontero1919
@sherlynmontero1919 Жыл бұрын
Please what is the medicine for broncial asthma
@daverei1211
@daverei1211 2 жыл бұрын
Thank you. My son would so regularly have asthma attacks when he got the flu that we learned the triggers and fine tuned the response. Though we also learned the hard way, if you go into emergency and say “he’s having another croup attack”, he’d be given a steroid and sent home. However if you said “he’s having another asthma attack” he’d get proper Athsma treatment.
@watermonkey1926
@watermonkey1926 2 жыл бұрын
Adding Magnesium infusion and SQ Epinephrine should help this prior to intubation
@scottslotterbeck3796
@scottslotterbeck3796 2 жыл бұрын
My wife has severe asthma and there seems no cure, just treatment. She's been intubated, but has survived each time, but it is touch and go. And she's avoided the ECMO so far. This is profound ICU territory, and it is stressful on family. 10 infusion pumps at once. We need a cure!!!
@Medcram
@Medcram 2 жыл бұрын
Check for sulfites in your diet (preservatives) Check for GERD and treat it Check for post nasal drip and treat it Check with your physician to see if LABA/LAMA/ICS combination inhaler is right. Consider singular Consider xolair Consider nucala Consider bronchothermoplasty It sounds serious. Check with your physician of course.
@scottslotterbeck3796
@scottslotterbeck3796 2 жыл бұрын
@@Medcram Thank you. She has a pulmonologist at UC Davis. She has tried what you mentioned, and been on two clinical trials. What gets her in trouble is a respiratory infection. Since we have avoided people because of Covid, she's not been in the hospital. (Silver lining) The last time I insisted on Albuterol in the hospital, constantly. Prior to that they were doing breathing treatments every four hours, and she ended up in the ICU each time. This last time I insisted on the constant Albuterol and a BiPap, and she avoided the ICU. I will mention these things to her. She goes through 8-10 vials of Albuterol each day. And she has nebulizers in house, car, my car. I really enjoy your channel. Also, I tried to get her to go to the asthma center in Denver, but she's afraid to leave home.
@TheArgos12
@TheArgos12 Жыл бұрын
I'm not a doctor, but just sharing my experience. I've had asthma since I was diagnosed at 6yrs, about 37 years now. I used to have asthma attacks a couple times a week and would go to the hospital about once a month. 22 years ago the doctors put me on advair- a long acting beta agonist or LABA. It is a combination of salmeterol and fluticasone.(I think there are a few different brands of LABA with a few different medicines.) Prescribed to take every 12 hours. Since I started taking that medicine I haven't had an asthma attack in 22 years. I also carry a rescue inhaler, albuterol. I have severe allergies and for that I take fluticasone nose spray at night and allegra (regular not allegra D) once a day in the daytime. If my allergies get really bad i might pop an extra allegra once in a while. If she has allergies, they need to be under control. Look into the LABA medicines with her doctor. (LABAs usually take a couple of weeks or so to really kick in and start to work, but its worked wonders for me.)
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
@@TheArgos12 Thank you. My wife developed asthma as an adult. She can't use an inhaler because she can't breathe in deeply enough anymore. She uses a nebulizer a dozen times a day, day and night. She moved into the spare room so her frequent treatments during the nighttime wouldn't wake me. When she was in the ICU two years ago they said she was the sickest patient they had. She can deal with it, as long as she does not get a respiratory infection, like a cold or the flu. We stopped going to church or seeing family except outdoors. On top of that she had a cardiac arrest in January. My CPU training saved her life.
@DeannaPiercy
@DeannaPiercy Жыл бұрын
@@scottslotterbeck3796 - I, too, have asthma which is set off by even a mild cold. I've avoided people due to Covid and have not had an attack in three years. No nebulizer treatments, no steroids, no ER visits. What a relief!
@The40yearoldVegan
@The40yearoldVegan 8 ай бұрын
I stopped eating meat and dairy asthma went away completely after being asthmatic from the age of 13.
@anitahendrix7573
@anitahendrix7573 Жыл бұрын
Been watching your videos and great explanation of copd and asthma. In the last year or so I have had wheezing on exhalation it has gotten worse the last month my GP told me I have allergies and perscribed Montelukast sodium 10mg. Not any better I have no history of any allergies copd or asthma am a non smoker and79yo. How can I get tested for what is going on???
@Medcram
@Medcram Жыл бұрын
Pulmonary function testing
@TheOnlysleeping89
@TheOnlysleeping89 2 жыл бұрын
Lower AC than 20, less tidal volume?
@greentea1986
@greentea1986 2 жыл бұрын
Why didn't the patient was started on IV mgso4 or sc bricanyl?
@forkswacarnivore7531
@forkswacarnivore7531 Жыл бұрын
Doc...why do so many doctors and pulmonary specialty doctors miss telling patients to eliminate all dairy even cheese? I took Florent 225mcg 2 puffs twice a day for years and carried an emergency albuteral inhaler. I went Carnivore to reverse T2 DM, hypothyroidism, hypertension and ckd. All of which I successfully cured. I then dropped dairy in an effort to loose a few pounds. Rather shockingly my allergies and chronic, severe asthma complete with a cough and wheezing went away in a week. Recently, one of my employees was really suffering with sinus pain, asthma, sniffing and even migrains she's been seeing a specialist for weekly. She is in her 60's speaks very little English..I told her NO MORE LECHE!!! She was eating lots of cheese and drinking a glass of milk at bedtime each night. 1 week in she is shocked..report's no more sinus issues or asthma, not using allergy meds anymore and Flovent is actually working now as it wasn't working for her recently. She is so happy as am I that it's working. Why do doctors not analyze what people are eating?
@whodidit99
@whodidit99 2 жыл бұрын
I have asthma. Is there any way to create pressure to aid exhalation? I remember attacks so severe my lung muscles were actually fatigued and could barely help with exaltation. I had to lay my chest on a table to exhale.
@Medcram
@Medcram 2 жыл бұрын
Need to get help before that happens. Try a peak flow meter daily so you know how you are doing before you get bad.
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
@@Medcram Using the peak flow meter gives my wife an asthma attack. She tracks her attacks using a pulse oximeter.
@stevesteves945
@stevesteves945 2 жыл бұрын
I know some of these words.
@k0smon
@k0smon 2 жыл бұрын
I would slow the control rate, increase sedation, and drop O2 to a level to maintain a reasonable O2 sat.
@imgadgetmanjim
@imgadgetmanjim 2 жыл бұрын
Paralytic, short I time to increase e time.
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
@@imgadgetmanjim they have put my wife in paralytics the ladt four times she's been intubated. Problem is, waking up paralyzed is not pleasant. My wife cried the first time it happened. Some people are partially paralyzed for life afterwards. So far, my wife has fully recovered, thank God.
@imgadgetmanjim
@imgadgetmanjim Жыл бұрын
@@scottslotterbeck3796 Paralytic should not be given without proper sedation. Sorry to hear that.
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
@@imgadgetmanjim oh, she was sedated. This was at a University of California hospital. This was about five years ago?
@idkwhattocallir75
@idkwhattocallir75 Жыл бұрын
History, physical exam (mental, aucultate wheeze/RR), vitals, ABG, steroids and Nebulization and repeat.
@idkwhattocallir75
@idkwhattocallir75 Жыл бұрын
Intubation.
@idkwhattocallir75
@idkwhattocallir75 Жыл бұрын
Xray = hyperexpansion hypotenison
@idkwhattocallir75
@idkwhattocallir75 Жыл бұрын
Incorrect ventilation=dynamic Resp viral infections = astham exacerbaiton Hx: Vitals Mental status Pex: auscultate ABG Steroid oxygen nebulizers Bipap Repeat ABG
@idkwhattocallir75
@idkwhattocallir75 Жыл бұрын
Beta receptor = musuclar relaxaiton Need to be activated Msucarinic need to be blocked Ipratropium Albuterol Resp acidosis Dt co2 acxumulation rather than change in bicarb Xray after bipap DHI dynamic hyperinflation
@prettyyoungthingpyt5015
@prettyyoungthingpyt5015 2 жыл бұрын
Why is Duoneb the go to treatment? Duoneb dries out asthmatics. We need just regular Albuterol. I demand only Albuterol whenever I'm in the hospital along with steroid. I'm now steroid dependent because of my asthma and diabetic because of the Prednisone. Damn if you don't, damn if you do. My doctor gave me Duoneb for home use but it is too drying, not to mention the antihistamine when I do take it. Doctors please understand that the anticholinergic drug will cause a mucus plug and increased difficulty breathing. Repeat Albuterol TX and hydration works wonders along with steroids of course.
@stevepottschmidt2903
@stevepottschmidt2903 2 жыл бұрын
Around the 5 minute mark he explains the mechanism of action of the combination in Duoneb. The ipratropium opens the airway by blocking the muscarinic receptor. It does dry up the mucus, also.
@prettyyoungthingpyt5015
@prettyyoungthingpyt5015 2 жыл бұрын
@@stevepottschmidt2903 my question was really a statement, not a question per se. Ipatropium is not a good drug for asthmatics as it dries up the mucus. We need that mucus loose and thin so we can cough it up and expel it. I had a horrible week using Duoneb. Ughh. I'll stick to plain old Albuterol.
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
Welcome to the Severe Asthma club. Not fun!
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
@@prettyyoungthingpyt5015 good to know. My wife uses Albuterol 8-10 a day with a nebulizer. She agrees she needs to cough up stuff. She used Mucinex for a long time.
@dvf4550
@dvf4550 2 жыл бұрын
Well that freaks me out a little bit. Especially during a pandemic. But regardless. I really don't like asthma. It is not fun. I pray frequently that my death someday will not involve not being able to breathe. Ah just ignore my negative attitudes. We just had two more family deaths this week, and it's affecting my attitude temporarily. Seven in less than a year, some with covid. I'll cheer up later. But I still really dislike having asthma and most of my relatives have it too. It's a family thing.🙄 We take it in stride. For some reason I found the video both informative and upsetting. Excellent video though.
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
My wife says it's like breathing through a straw. Very scary!
@dvf4550
@dvf4550 Жыл бұрын
@@scottslotterbeck3796 It can be yes. Once I sat on my husband's chest to help him understand. When he commented how hard it was to breathe in with my weight on his chest, I told him, That's what it feels like.
@Idiotsincarshere
@Idiotsincarshere 2 жыл бұрын
I didn't expect all the pseudo science comments from non medical professionals here.
@MarkShinnick
@MarkShinnick 2 жыл бұрын
You'd be amazed what too many MDs don't understand.
@Madronaxyz
@Madronaxyz 2 жыл бұрын
Hi. Retired medical doctor here. 95% of adult asthma is allergy mediated. The problem is, the insurance industry has taken over health Care and doctors are not allowed enough time to figure out what is wrong with people. I graduated medical school around 1980. By the time I retired, 30 years later, I had to do five times as much work for an hour's pay and my pay was 60% lower than it was 17 years earlier. Doctors are overworked, nurses are overworked, you can't get lab results at night anymore, and you spend unpaid hours, literally hours, I mean like I once spent 4 hours on the phone trying to get life saving care for patient. The insurance company denied it. Another doctor was on the phone next to me and we both finally had to get off the phone from the insurance company about the same time. We just gave each other a hug and cried for about 3 or 4 minutes. The United States for profit healthcare system has made magnificent salaries for insurance company and hospital corporation ceos. Dollar bill Maguire, over the 10 years he was at United healthcare, took 10 billion in compensation. You have to deny a lot of healthcare to give that much money to one man. So is it any surprise that the United States has some of the worst healthcare outcomes in the developed world, the shortest life expectancy in the developed world?
@MarkShinnick
@MarkShinnick 2 жыл бұрын
@@Madronaxyz I'm saving your valuable text here, thank you for this. The authoritarian abuse of MD's and patients in HC appears essentially coordinated, also with Pharma, where the legal meeting of standard of care is sufficed with agents labeled for the diagnosis. Once the legal standard is met, the system can defend itself; to Hell with anything else.
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
@@Madronaxyz The USA has the best healthcare system in the world, but it is too bureaucratic, too expensive, and making obscene money is evil. I agree. But government-run health care is far worse. I have incurable cancer, but I'm still here after 23+ years because I researched doctors specializing in my cancer, and found a dictor who was an expert in that cancer, a published researcher, and have been on five clinical trials. Also, of course, by the grace of God. I would be dead if I lived in a country with socialized medicine. Zero question. A doctor from the UK laughed when I asked him and he said yes, I would be. They simply do not have access to the latest drugs.
@TenMillionYearProgram42
@TenMillionYearProgram42 2 жыл бұрын
Good to finally see a video that's not about the WuFlu. We can only go over the intricacies of a cold for so long. Welcome back!
@theDemong0d
@theDemong0d 2 жыл бұрын
Regardless of your opinion of the disease, the COVID-19 pandemic has been by far the most heavily studied pandemic in history and is immensely interesting from an epidemiological standpoint, so it's well worth studying in great detail even though the disease seems to be mutating to be less damaging.
@scottslotterbeck3796
@scottslotterbeck3796 Жыл бұрын
Covid is still killing people. Stop making light of this killer. Over 5 million dead. It is not a hoax. Dr. Seheult is a God send for me! I'm a cancer survivor at high risk of death, and his video #59 (?) is a life saver!!!
@janeteddddd
@janeteddddd Жыл бұрын
I believe my daughter got asthma through a childhood Vv@×ination.
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