Status Asthmaticus

Report:

Sinus rhythm

Right atrial abnormality

ST/T changes consistent with ischæmia or hypoxia

Comment:

Tachycardia is conspicuous for its absence and is as sinister as was the absence of audible wheezing. The repolarisation changes reflect profound hypoxæmia and mixed acidosis. They resolved within 14 hours (Fig 209a). In critical care units, some of the most florid “ischæmic” traces are obtained on subjects with systemic, rather than coronary, disease.

The patient survived; it is rare at present to “lose” an asthmatic who had not sustained irreversible brain damage or barotrauma prior to admission. Asthmatics sometimes deteriorate further on positive pressure ventilation but in this case the situation became so desperate that I applied, for the first time, external expiratory assistance popularised by Malcolm Fisher151.

Some of the scary rhythm strips are shown overpage (Fig 209b).

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