Guidelines for the management of asthma: a summary. British Thoracic Society and others.

Clinicians should be aware that bacterial meningitis can present quite atypically, with the sudden onset of severe behavioural disturbance closely mimicking substance abuse, and should avoid potentially disastrous delays in treatment.

Abstract

Acute severe asthma in adults Recognition and assessment in hospital Features of acute severe asthma * Can't complete sentences in one breath * Respirations 225 breaths/min * Pulse 11O beats/min * Peak expiratory flow (PEF) s 50% of predicted * or best Life threatening features * PEF <33% of predicted or best * Silent chest, cyanosis, or feeble respiratory effort * Bradycardia or hypotension * Exhaustion, confusion, or coma If a patient has any of these features, then measure arterial blood gases.Markers of a very severe, life threatening attack: * Normal (5-6 kPa, 36-45 mm Hg) or high Faco2 * Severe hypoxia: Pao2 <8 kPa (60 mm Hg) irrespective of treatment with oxygen * A low pH (or high H+) No other investigations are needed for immediate management.