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Example text

2). However, with regard to the particular diagnosis of PE, proceed as follows. Cardiovascular The most common sign is sinus tachycardia. BP may be elevated due to catecholamine release or may be reduced secondary to cardiovascular collapse. Most importantly, look for signs of pulmonary hypertension: • elevated venous pressure, particularly with an exaggerated a wave; • right ventricular heave, which can develop surprisingly rapidly following an acute rise in pulmonary artery pressure; • right ventricular gallop rhythm and loud pulmonary second sound.

ECG: sinus tachycardia will be the likely finding, but it is important to exclude any tachyarrhythmias that may result primarily as a result of cardiac compromise or secondarily to treatment strategies (ie β2-agonists or theophyllines). Management Assuming that the history and examination are consistent with the diagnosis of an acute exacerbation of asthma, then oxygen, bronchodilators and steroids are the first-line treatments. • Oxygen: maximum inspired oxygen by face mask should be administered.

Do not delay: asthmatics can deteriorate rapidly. If life-threatening features are present or the patient does not improve with the initial treatment after 15 –30 minutes, then further treatments needs to be administered. 0 g over 20 minutes. This works as a calcium antagonist that induces smooth muscle relaxation. A single dose of intravenous magnesium sulphate has been shown to be effective and safe in acute severe asthma (the safety of repeated doses is yet to be assessed). • Intravenous bronchodilators: aminophylline should be used with caution, especially if oral theophyllines are part of the patient’s regular medication.

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