This case comes from Dr. Helene Morakis.
Dr. Morakis is a PGY5 Emergency Medicine resident at the University of British Columbia. Her interests include prehospital medicine, wilderness medicine, and simulation. She completed her medical degree at Queen’s University.
WHY IT MATTERS
Asthma exacerbation can progress quickly and become severe despite conventional therapies. Taking decisive action and escalating therapy, including adjuncts, can be life saving and prevent intubation and mechanical ventilation. Pregnant patients have a number of physiologic changes that effect asthma including baseline hyperventilation and reduced diaphragmatic excursion secondary to the gravid uterus. This cases provides an opportunity to review these differences and mitigate them in a critically ill asthma patient.
CLINICAL VIGNETTE
30 y/o F G1P0 at 35 weeks GA presents with shortness of breath increasing over the last few days. She has a cough and ran out of salbutamol overnight which is why she came to the ED this morning.
CASE SUMMARY
A third trimester patient presents with a severe asthma exacerbation that deteriorates and requires BiPAP/ICU admission. The learner will need to identify severe asthma and manage accordingly accounting for differences in physiology during pregnancy.
Case courtesy of Henry Knipe, Radiopaedia.org. From the case rID: 36714
Patel, Nirav & Negi, Smita & Anand, Aashish & Rao, Anantha. (2016). The New Zealand medical journal. 129. 80-83.
EM Sim Cases 