Status asthmaticus physical examination

• Sit upright with arms extended to support the upper chest (tripod position) that assists the use of accessory muscles of respiration

• Increased respiratory rate greater than 30 cycles per minute
• Increased heart rate
• Pulsus paradoxus (fall in SBP greater than 20-40 mmHg during inspiration)

• Use of accessory muscles of respiration such as sternocleidomastoid, scalene and intercostal muscles, correlates with the disease severity
• Intercostal retractions
• Paradoxical thoraco-abdominal breathing

• High-pitch prolong polyphonic expiratory wheeze
• Bilateral crackles
• Air entry may or may not be reduced depending on the disease severity
• Absence of wheeze and breath sounds secondary to severe airway obstruction may represent a silent chest which is an ominous sign of imminent respiratory failure.

Progressive untreated airway obstruction and increased work of breathing eventually leads to worsening hypoxemia, hypercarbia and increased air trapping with compromised stroke volume that results in bradycardia, hypotension, hypoventilation and subsequent cardiorespiratory arrest.

• Level of consciousness ranges from lethargy, agitation to even loss of consciousness or seizure, secondary to severe airway obstruction, hypoxia and carbon-di-oxide retention.
• Unable to speak in full sentences

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