Status asthmaticus physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

Vital Signs

• Increased respiratory rate greater than 30 cycles per minute
• Increased heart rate
• Pulsus paradoxus (fall in SBP greater than 20-40 mmHg during inspiration)

General Physical Examination

• Sit upright with arms extended to support the upper chest (tripod position) that assists the use of accessory muscles of respiration
• Peak flow rate measurement is a simple bedside method to assess the severity of airway obstruction. A red zone indicates less than 50% of the usual or normal peak flow reading signifying a severe airway obstruction.

Respiratory Examination

Inspection

• Use of accessory muscles of respiration such as sternocleidomastoid, scalene and intercostal muscles, correlates with the disease severity
• Intercostal retractions
• Paradoxical thoraco-abdominal breathing

Auscultation

• High-pitch prolong polyphonic expiratory wheeze
• Bilateral crackles
• Air entry may or may not be reduced depending on the disease severity
• Absence of wheeze and breath sounds secondary to severe airway obstruction may represent a silent chest which is an ominous sign of imminent respiratory failure.

Cardiovascular Examination

Progressive untreated airway obstruction and increased work of breathing eventually leads to worsening hypoxemia, hypercarbia and increased air trapping with compromised stroke volume that results in bradycardia, hypotension, hypoventilation and subsequent cardiorespiratory arrest.

Neurological Examination

• Level of consciousness ranges from lethargy, agitation to even loss of consciousness or seizure, secondary to severe airway obstruction, hypoxia and carbon-di-oxide retention.
• Unable to speak in full sentences