Acute hypoxic and hypercapnic respiratory failure
Asthma exacerbation

yo M/F with PMH of , presenting with
 days constant/intermittent progressively worsening/improving

  • CC: shortness of breath

  • PP: wheezing, chest tightness, cough, nocturnal symptoms, increased work of breathing, accessory muscle use

  • PN: no chest pain, no unilateral leg swelling, no hemoptysis, no recent immobilization/travel, no fever/chills

  • Pertinent SHx: tobacco/vape use, marijuana/cocaine use, EtOH, allergen/environmental exposure

  • Etiology: likely triggered by viral URI, allergen exposure, smoke/vape exposure, medication noncompliance, exercise/cold air

  • Risk factors: prior ICU/intubation, frequent steroid use, poor inhaler adherence, smoking/vaping, uncontrolled allergies, obesity

  • Initial DATA: CBC, BMP, mag, phos, VBG/ABG if severe, CXR

  • Pending DATA: respiratory viral panel/COVID-flu, peak flow reassessment, sputum culture if productive cough/infectious concern

  • MEDS:

  • COURSE:

Plan

  • Scheduled albuterol or duonebs q4h / albuterol q2 PRN; space as tolerated

  • PO prednisone 40–60 mg daily for 5 days; if unable to tolerate PO, methylprednisolone IV then transition to PO when able

  • Magnesium sulfate IV if severe exacerbation or poor initial response

  • Supplemental O2 PRN to maintain SpO2 >92%

  • Monitor daily CBC, BMP; tele if severe exacerbation/tachyarrhythmia risk

  • Bronchopulmonary hygiene: incentive spirometry/PEP flutter if needed

  • Treat underlying trigger if identified (viral URI/allergen exposure)

  • Resume/optimize maintenance inhalers (ICS/LABA) prior to discharge

  • Smoking/vaping cessation counseling

  • Pulm consult if refractory symptoms, recurrent admissions, or severe persistent asthma

  • BiPAP/NIPPV if severe increased WOB, hypercapnia, or impending respiratory failure

  • VBG/ABG PRN for worsening respiratory status

  • Ambulatory O2 evaluation prior to DC if persistent hypoxia