# Asthma — GCMD Library living collection

Everything in the library about asthma — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 70 cited statements

## Episodes
### Diagnosis & Workup
- [Update Course Rewind: CT Evaluation of Suspected Airway Foreign Body 2022](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632.md)

### Acute Management
- [Reunión de la Medicina de Emergencia - Controversias en el manejo del asma grave en urgencias](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634) — video · 51:08 · [machine version](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634.md)

### Surgical Management
- [Tricks - Supine Positioning For Bilateral VATS](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638) — video · 17:04 · [machine version](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=0) Case Presentation: Bilateral Supine VATS for Spontaneous Pneumothorax (Ep 1)
- [5:20](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=320) Indications and Patient Selection for Supine VATS (Ep 1)
- [9:15](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555) Technical Details: Double-Lumen Intubation and Exposure (Ep 1)
- [11:28](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688) Pleurodesis Techniques: Mechanical, Chemical, and Pleurectomy Debate (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=0) Case presentation and clinical scenario (Ep 2)
- [0:52](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=52) Study design and CT-first protocol outcomes (Ep 2)
- [1:42](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=102) Clinical rationale and false positive discussion (Ep 2)
- [2:59](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=179) False negatives and detection capabilities (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=0) Introductions and Framing the Controversy (Ep 3)
- [2:32](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=152) Defining Severe Asthma and Status Asthmaticus (Ep 3)
- [8:42](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=522) First-Line Therapy: MDI with Spacer vs. Nebulization (Ep 3)
- [14:10](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=850) Role of Ipratropium and Second-Line Agents (Ep 3)
- [18:03](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1083) Continuous Nebulization Technique and Oxygen Source (Ep 3)
- [22:34](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1354) Monitoring Response and Escalation Triggers (Ep 3)
- [27:35](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1655) Corticosteroid Route: Oral, Inhaled, or Intravenous (Ep 3)
- [32:37](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1957) Intramuscular Epinephrine in Critical Asthma (Ep 3)
- [38:29](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2309) Corticosteroid Agent Selection and High-Flow Oxygen (Ep 3)
- [44:39](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2679) Aminophylline, Ketamine, and Non-Invasive Ventilation (Ep 3)
- [49:48](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2988) Intubation Strategy and Closing Remarks (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Lateral decubitus positioning has been adopted from the transition from open thoracotomy to VATS and provides ease of exposure and rapid conversion to open thoracotomy, but with advancements in VATS this no longer applies." — Nick Bruns (opinion) [Ep 1 · 0:45](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=45)
- "Lateral positioning may add unnecessary morbidity including brachial plexus injury and decubitus ulcers." — Nick Bruns (clinical) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=90)
- "The patient is a 17-year-old male with history of asthma who presented with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, later developing a small left spontaneous pneumothorax that resolved with observation." — Nick Bruns (clinical) [Ep 1 · 1:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=100)
- "Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in the supine position due to the routine nature of the procedure." — Nick Bruns (clinical) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=140)
- "Port placement for supine VATS included 25mm ports at the 7th intercostal space midclavicular line and 6th intercostal space mid-axillary line, plus a 12mm port at the 4th intercostal space mid-axillary line to accommodate the GIA stapler." — Nick Bruns (clinical) [Ep 1 · 2:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=160)
- "Bilateral VATS was safely completed in the supine position, providing simplicity, convenience, decreased operative time, and decreased positioning-related morbidity." — Nick Bruns (opinion) [Ep 1 · 4:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=280)
- "Patient selection for supine VATS is important; appropriate cases include bilateral VATS with low morbidity and well-defined pathology where you won't encounter surprises." — Nick Bruns (clinical) [Ep 1 · 6:09](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=369)
- "Bilateral thoracic sympathectomies for hyperhidrosis can be performed in the supine position at one sitting." — Jose (clinical) [Ep 1 · 6:30](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=390)
- "For sympathectomy in supine position, the lung falls away adequately with table tipping and CO2 compression of the lung to help with exposure." — Jose (clinical) [Ep 1 · 7:19](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=439)
- "Supine VATS is useful in low-risk-to-conversion thoracoscopic cases; any low-risk pleural-based lesion case for biopsy or superficial wedge resection would be applicable, but if there's high risk of conversion or difficulty with exposure, traditional decubitus positioning is preferred." — Mark McCollum (clinical) [Ep 1 · 7:58](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=478)
- "Bilateral phrenic nerve stimulators for patients with central hyperventilation syndrome can be placed in supine position because the phrenic nerve is quite anterior." — Sharif (clinical) [Ep 1 · 9:15](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555)
- "In the presented case, a double-lumen tube was used with positive pressure in the chest being worked on, providing great exposure." — Mark McCollum (clinical) [Ep 1 · 10:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- "Mechanical pleurodesis was performed circumferentially from about the 5th intercostal space up to the apex, which was as easy as the standard approach with decubitus positioning." — Mark McCollum (clinical) [Ep 1 · 10:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- "The patient was moved to the side edge of the bed to allow full mobility of the surgeons' hands." — Mark McCollum (clinical) [Ep 1 · 10:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- "Parietal pleurectomy is fairly easy—you get into the space underneath the parietal pleura and strip it off—and is a far more effective way to seal the pleural cavity than mechanical pleurodesis." — Jeff Blair (opinion) [Ep 1 · 11:28](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- "There have been recurrences after mechanical pleurodesis, but no recurrences after pleurectomy in the speaker's experience." — Jeff Blair (clinical) [Ep 1 · 11:28](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- "The blood patch technique is very effective for pleurodesis, and you don't want to suction out any blood for this reason." — Jack (clinical) [Ep 1 · 12:12](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=732)
- "Pleurodesis may not be necessary in these cases because the cause of the problem is blebs in the apex of the lung; removing the blebs should prevent recurrent pneumothorax." — Jack (opinion) [Ep 1 · 12:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=760)
- "Blebs are not just a one-point-in-time thing; they have to do with the anatomy of the lung and overstretch, so if you take out one bleb, another bleb could form in a few months." — Jack (opinion) [Ep 1 · 12:57](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=777)
- "These are congenital blebs that don't form over time at age 16." — Jack (opinion) [Ep 1 · 13:10](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=790)
- "There are certain congenital problems where you go in and there are blebs all over the place; you see the largest ones at the apex and assume those burst, but you can have blebs you can't see or identify." — Cathy (clinical) [Ep 1 · 13:35](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- "The speaker strips the cupola of the pleura and uses the abrading technique for the lower aspects of the chest where stripping becomes harder." — Cathy (clinical) [Ep 1 · 13:35](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- "Pleurectomy is incredibly painful postoperatively." — Jeff Blair (clinical) [Ep 1 · 14:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=874)
- "Patients who received talc pleurodesis had more pain postoperatively compared to mechanical pleurodesis, based on anecdotal observation." — Sharif (clinical) [Ep 1 · 15:05](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=905)
- "Pleurectomy and talc are very painful postoperatively, and if you've ever had to re-operate in a chest that's had talc in it, you'll never do it again because the whole lung becomes frozen." — Mark McCollum (clinical) [Ep 1 · 15:32](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- "Mechanical pleurodesis works effectively because you just need the apex of the lung to stick up, not the whole lung frozen." — Mark McCollum (opinion) [Ep 1 · 15:32](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- "In the presented case, when starting on the right side, the area where the previous bleb had spontaneously erupted was well adhered to the apex of the chest." — Mark McCollum (clinical) [Ep 1 · 15:32](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- "The more painful the pleurodesis, probably the more effective it is." — Jack (opinion) [Ep 1 · 16:01](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=961)
- "Once you start pleurectomy, it's hard to stop because it strips away easily, and with modern analgesics the pain is manageable." — Jeff Blair (clinical) [Ep 1 · 16:29](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=989)
- "Multiple clinical scoring systems exist to define asthma severity (pulmonary score, respiratory rate, retractions, oxygen saturation), but they are not uniformly validated or applied." — Natalia Paniagua (clinical) [Ep 3 · 2:32](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=152)
- "When scoring systems disagree on severity category, the higher (more severe) category should be used to guide treatment." — Natalia Paniagua (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=180)
- "The term 'status asthmaticus' should be reserved for patients who do not respond to initial treatment, not applied at presentation." — Natalia Paniagua (opinion) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=195)
- "Recognizing respiratory insufficiency (not just respiratory distress) is critical; insufficiency indicates impending failure and requires escalation." — Natalia Paniagua (clinical) [Ep 3 · 3:30](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=210)
- "Lack of uniform definitions of 'severe asthma' and 'status asthmaticus' in the literature makes it difficult to compare studies of treatment efficacy." — Natalia Paniagua (opinion) [Ep 3 · 4:00](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=240)
- "Meta-analyses and large studies show that metered-dose inhalers with spacers are as effective as nebulization in mild-to-moderate asthma exacerbations." — Javier Benito (host_summary) [Ep 3 · 8:58](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=538)
- "In severe asthma, MDI with spacer can be effective if the patient can generate adequate inspiratory flow (at least 40 liters per minute) and the spacer valve functions properly." — Javier Benito (clinical) [Ep 3 · 9:40](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=580)
- "Adding ipratropium bromide to salbutamol in the first-line treatment of severe asthma reduces hospital admission rates, particularly in children over 5 years of age." — Javier Benito (host_summary) [Ep 3 · 11:42](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=702)
- "Ipratropium has a good safety profile with minimal side effects compared to other bronchodilators." — Javier Benito (clinical) [Ep 3 · 12:30](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=750)
- "In Cincinnati, the default approach for severe asthma is to use MDI with spacer at the bedside to avoid delays and reduce infection risk, reserving nebulization for patients who cannot cooperate or generate flow." — Javier González del Rey (clinical) [Ep 3 · 12:57](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=777)
- "In Paraguay, continuous nebulization is initiated in severe cases because it is operationally simpler for nursing staff to manage in the first hour of treatment." — Viviana Pullich (clinical) [Ep 3 · 14:10](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=850)
- "In Spain (Natalia's institution), only 5% of children with asthma exacerbations receive nebulization; the rest are treated with MDI and spacer." — Natalia Paniagua (clinical) [Ep 3 · 24:12](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1452)
- "Nebulization is reserved for children who cannot use a spacer due to severity of distress or other factors." — Natalia Paniagua (clinical) [Ep 3 · 24:40](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1480)
- "Second-line therapies for severe asthma include intravenous magnesium sulfate, high-flow nasal cannula oxygen, and intravenous bronchodilators (salbutamol or terbutaline)." — Javier Benito (clinical) [Ep 3 · 14:10](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=850)
- "The choice and timing of second-line therapies depend on the patient's response to first-line treatment and the severity of presentation." — Javier Benito (clinical) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=900)
- "Intravenous magnesium sulfate is used when the patient does not respond adequately to initial bronchodilators and corticosteroids." — Javier Benito (clinical) [Ep 3 · 18:03](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1083)
- "High-flow nasal cannula oxygen improves patient comfort and may reduce the need for intubation in severe asthma." — Javier Benito (clinical) [Ep 3 · 18:30](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1110)
- "Close bedside monitoring in the first hour is essential to detect failure to respond to initial therapy; the first two doses of bronchodilator (given every 10-20 minutes) are the most important window for assessment." — Natalia Paniagua (clinical) [Ep 3 · 25:56](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1556)
- "If a patient shows initial improvement but then deteriorates (e.g., heart rate drops, work of breathing worsens), escalation to magnesium or other second-line therapy is indicated." — Natalia Paniagua (clinical) [Ep 3 · 27:00](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1620)
- "In selected patients with severe asthma who do not have respiratory failure, oral or inhaled corticosteroids are as effective as intravenous corticosteroids." — Natalia Paniagua (host_summary) [Ep 3 · 27:35](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1655)
- "In critically ill patients with impending respiratory failure, intravenous corticosteroids are preferred for speed and reliability of delivery." — Viviana Pullich (clinical) [Ep 3 · 28:20](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=1700)
- "There is no strong evidence favoring one corticosteroid agent (methylprednisolone, dexamethasone, prednisone) over another in acute asthma." — Natalia Paniagua (host_summary) [Ep 3 · 39:43](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2383)
- "Intramuscular epinephrine (or terbutaline) can be used in the critically ill asthmatic patient who cannot inhale medications due to severe respiratory distress, minimal air movement, or altered mental status." — Viviana Pullich (clinical) [Ep 3 · 35:18](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2118)
- "The 'perfect storm' patient for IM epinephrine has marked suprasternal and intercostal retractions, minimal air movement on auscultation, oxygen saturation below 92%, and is in the resuscitation bay." — Viviana Pullich (clinical) [Ep 3 · 33:49](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2029)
- "Historically, before nebulization was standard, repeated doses of intramuscular adrenaline were used to treat severe asthma exacerbations." — Natalia Paniagua (clinical) [Ep 3 · 37:23](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2243)
- "Aminophylline (theophylline) has a narrow therapeutic window and many side effects (tachycardia, arrhythmias, gastrointestinal upset), making it less favorable for routine use." — Viviana Pullich (clinical) [Ep 3 · 41:47](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2507)
- "Aminophylline is used only occasionally and anecdotally in severe asthma, particularly when other therapies have failed." — Viviana Pullich (clinical) [Ep 3 · 42:40](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2560)
- "Non-invasive ventilation (e.g., BiPAP) is preferred over aminophylline or ketamine as a next step in escalation for severe asthma." — Natalia Paniagua (opinion) [Ep 3 · 44:43](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2683)
- "Ketamine is considered a drug of choice for sedation during intubation in severe asthma because of its bronchodilator properties." — Viviana Pullich (clinical) [Ep 3 · 43:10](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2590)
- "Some clinicians attempt ketamine sedation without paralytic agents as a bridge to see if the patient improves before committing to full intubation and mechanical ventilation." — Viviana Pullich (clinical) [Ep 3 · 49:48](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2988)
- "Mechanical ventilation in severe asthma is not ideal and should be avoided if possible; it requires ICU-level expertise in airway management and ventilator settings." — Viviana Pullich (clinical) [Ep 3 · 43:50](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2630)
- "High-flow nasal cannula oxygen is increasingly used as a comfort measure and to delay or avoid intubation in severe asthma." — Javier Benito (clinical) [Ep 3 · 41:01](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2461)
- "The availability of ICU beds and airway management expertise influences the threshold for escalating to mechanical ventilation." — Javier Benito (clinical) [Ep 3 · 41:30](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2490)
- "Lack of uniform severity definitions and treatment protocols across institutions makes it difficult to conduct high-quality comparative studies of second-line therapies in severe asthma." — Javier Benito (opinion) [Ep 3 · 45:37](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2737)
- "Future research should focus on developing uniform criteria for defining critical asthma and respiratory failure to enable better evidence generation for second-line treatments." — Javier Benito (opinion) [Ep 3 · 46:40](https://library.globalcastmd.com/watch/reuni-n-de-la-medicina-de-emergencia-controversias-en-el-manejo-del-asma-grave-en-urgencias-6634?t=2800)
- "In the study by Dr. Ponsky, cohort one went straight to bronchoscopy, while cohort two underwent CT scan first" (host_summary) [Ep 2 · 0:52](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=52)
- "In the CT-first cohort, if the CT scan was negative, the child was sent home; if positive, the child went to the operating room" (host_summary) [Ep 2 · 0:52](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=52)
- "In patients who went to the operating room based on positive CT, 94% of the time they actually found a foreign body" (host_summary) [Ep 2 · 0:52](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=52)
- "More often than not, in cases with suspicious story of aspiration, it's reactive airway and not a foreign body" — Chuck Snyder (clinical) [Ep 2 · 1:42](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=102)
- "Instrumenting the airway of kids that already have a reactive airway when there is no foreign body makes no sense" — Chuck Snyder (opinion) [Ep 2 · 1:42](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=102)
- "The institution was having a lot of negative bronchoscopies because of high concern about missing foreign bodies" — Chuck Snyder (clinical) [Ep 2 · 1:42](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=102)
- "CT scan will direct management regarding whether the patient needs to go to the operating room or not" — Chuck Snyder (clinical) [Ep 2 · 1:42](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=102)
- "The CT scan for airway foreign body has very low radiation exposure" (host_summary) [Ep 2 · 2:32](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=152)
- "CT eliminates unnecessary instrumentation of the airway in equivocal patients with reactive airway disease" (host_summary) [Ep 2 · 2:32](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=152)
- "False positives on CT for airway foreign body were very unusual, approximately 6%" — Chuck Snyder (clinical) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=179)
- "False negatives can only be determined by whether something happened to the patient afterwards" — Chuck Snyder (clinical) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=179)
- "Of all patients with negative CT who were called for follow-up, not a single one had any problems after discharge from the emergency room" — Chuck Snyder (clinical) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=179)
- "CT for airway foreign body is incredibly surprisingly accurate" — Chuck Snyder (opinion) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=179)
- "Foreign bodies do not need to be radiopaque to be detected on CT" — Chuck Snyder (clinical) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=179)
- "CT can detect plastic foreign bodies and other non-radiopaque materials" — Chuck Snyder (clinical) [Ep 2 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-ct-evaluation-of-suspected-airway-foreign-body-2022-6632?t=179)

## Changelog
- Sep 25: 3 items added automatically

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