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CMV pneumonitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Status asthmaticus is an medical emergency caused by an acute exacerbation of asthma that does not respond to standard bronchodilator and corticosteroid therapy. Symptoms include chest tightness, rapidly progressive dyspnea, non-productive cough and wheezing. Status asthmaticus if left untreated may result in severe bronchospasm, mucus plugging and rapidly develops acidosis and respiratory failure as a consequent of carbon dioxide retention and hypoxemia.

Epidemiology and Demographics

Approximately 10% of the US population is affected by asthma and an increased prevalence of 60% is observed in all age groups, with status asthmaticus requiring the highest rates of hospitalization.[1]

Diagnosis

Electrocardiogram

The presence of supraventricular tachycardia on ECG should raise a suspicion of theophylline toxicity.

CT

High-resolution CT may reveal several structural changes related to small-airway disease including cylindrical bronchiectasis, bronchial wall thickening, and air trapping.[2]

Other Diagnostic Studies

FEV1 lower than 60% predicted is strongly suggestive of severe airway obstruction. Peak flow rate measurement is a simple bedside method to assess the severity of airway obstruction. A red zone indicates less than 50% of the usual or normal peak flow reading signifying a severe airway obstruction.

Treatment

Medical Therapy

Initial severity assessment is evaluated using arterial blood gas and pulmonary function test and aggressive therapy is initiated to prevent progression to respiratory failure.

References

  1. Gorelick M, Scribano PV, Stevens MW, Schultz T, Shults J (2008) Predicting need for hospitalization in acute pediatric asthma. Pediatr Emerg Care 24 (11):735-44. DOI:10.1097/PEC.0b013e31818c268f PMID: 18955910
  2. Robards VL, Lubin EN, Medlock TR (1975) Renal transplantation and placement of ileal stoma. Urology 5 (6):787-9. PMID: 1094668


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Historical Perspective

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References

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Classification

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References

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Pathophysiology

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References

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Causes

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References

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Differentiating Status asthmaticus from other Diseases

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References

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Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Approximately 10% of the US population is affected by asthma and an increased prevalence of 60% is observed in all age groups, with status asthmaticus requiring the highest rates of hospitalization.[1]

References

  1. Gorelick M, Scribano PV, Stevens MW, Schultz T, Shults J (2008) Predicting need for hospitalization in acute pediatric asthma. Pediatr Emerg Care 24 (11):735-44. DOI:10.1097/PEC.0b013e31818c268f PMID: 18955910


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Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Risk Factors

  • Increased use of bronchodilator despite resistance,
  • Frequent exacerbations despite the use of corticosteroids,
  • Despite adhering to therapy, a peak flow rate of less than 10% from baseline,
  • Frequent hospitalization for acute attacks,
  • History of syncope or seizure during an acute asthmatic attack,
  • Oxygen saturation lower than 92% despite supplemental oxygen,
  • Airway obstruction is significantly reduced, resulting in severe impairment of air motion that leads to a silent chest with the absence of wheeze suggestive of an imminent respiratory arrest.

References

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Screening

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References

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Natural History, Complications and Prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Complications

References

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Diagnosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

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