Emergency Medicine

BREATHLESS PATIENT

66 General Medical Emergencies

3 Add ipratropium (Atrovent™) 500 g to a second dose of salbutamol 5 mg

via the nebulizer if there is no response, or there is a severe attack.

4 Involve the senior ED doctor if the patient is still wheezy, and perform the

following:

(i) Give prednisolone 50 mg orally or hydrocortisone 200 mg i.v. if

unable to swallow.

(ii) Repeat the salbutamol 5 mg via the nebulizer up to every

15–30 min, or even via continuous nebulization.

(iii) Send blood for white cell count (WCC), urea and electrolytes

(U&Es) and blood sugar. Commence an i.v. infusion of normal

saline for dehydration, with added potassium if low.

5 Perform a CXR only when a pneumothorax, pneumomediastinum or an

infection with consolidation is suspected, or the patient is not improving.

Women

Height (cm)

190

183

175

167

160

Height (cm)

175

167

160

152

145

Peak expiratory flow rate (L/min)

650

600

550

500

450

400

15 20 25 30 35 40 45 50 55 60 65 70

Age (Years)

Men

Figure 2.1 Predicted normal peak expiratory flow rates in adult men and women.

Reproduced by kind permission of Clement Clark International Ltd.