SinaiEMSinaiEMSinaiEMSinaiEM
  • Faculty
  • Faculty

    Home Pearls
    NextPrevious

    By taylor | Pearls, urgent care | Comments are Closed | 7 August, 2012 | 0

    A 29 y/o female with NIDDM and poorly controlled chronic asthma present s with 3days of sob and wheezing typical of her prior asthma exacerbations.  After two nebulizer treatments and dose of corticosteroids her PEFR is measured at 55% of predicted.  Should she be admitted?

    PEFR is not going to make this decision for you.

    PEFR monitoring has not been shown to reliably predict need for admissions among patients who, or relapse from outpatient treatment.

    Using specific PEFR cut offs for admission have led to increased admission rates without improving outcome measures.

    Severely diminished PEFR (e.g. <100ml/min) post treatment have been shown to require inpatient treatment, but these are not patients in which the admission decision is otherwise in question.

    ACEP recommends PEFR to assess treatment progress in particular patients per clinician judgment in the ED setting, but not as a requirement for evaluating all asthma patients or as admission criteria. 

     

     

    References:

    American College of Emergency Physicians. Use of Peak Expiratory Flow Rate Monitoring for the Management of Asthma in Adults in the Emergency Department. Ann Emerg Med. 2001;38:198

    Abisheganaden J, Ng SB, Lam KN, et al. Peak expiratory flow rate guided protocol did not improve outcome in emergency room asthma. Singapore Med J. 1998;39:479-484.

    Banner AS, Shah RS, Addington WW, et al. Rapid prediction of need for hospitalization in acute asthma. JAMA 1976;235:1337-8.

    Corre KA, Rothstein RJ. Assessing severity of adult asthma and need for hospitalization. Ann Emerg Med 1985;14:45-52.

    Emerman CL, Woodruff PG, Cydulka RK, et al. Prospective multicenter study of relapse following treatment for acute asthma among adults presenting to the emergency department. MARC investigators. Multicenter Asthma Research Collaboration. Chest.1999;115:919-927.

    Nowak RM, Pensler MI, Sarkar DD, et al. Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma. Ann Emerg Med..1982;11:64-69.

    No tags.
    NextPrevious
    • Resident Login
    • Schedules
      • Qgenda
      • Schedule Request Form (All Sites)
      • Moonlighting Requests
        • Sinai Moonlighting Request Form
        • Elmhurst Moonlighting Request Form
        • BI Moonlighting Request Form
        • PEM Moonlighting Request Form
        • MSBI Urgent Care Moonlighting Request Form
      • Moonlighting Payment Form
    • PEARL PUSHERS
    • Shift Resources
      • Consent Forms
      • Regional Anesthesia Guide
      • Critical Care Protocols
      • Shout Out Form
      • Checklists
        • Start of Shift Checklists
          • General Start of Shift Checklist (EMUpdates)
          • Cardiac
          • Resus Checklist 5.0
          • Resus
          • Trauma
          • RACC Restocking Checklist
        • Intubation Checklist (EMUpdates)
        • PSA Checklist (EMUpdates)
      • PEM Resources
        • CHOP ED Clinical Pathways
        • StatPearls
        • PEM Database
      • Mental Health Resources
    • Resus
      • Resus Checklist 5.0
    • Ultrasound
    • People
      • Residents
      • Faculty
      • Division of Critical Care
      • PEM Fellows
      • Residency Newsletters
        • Summer 2017
        • Winter 2016
        • Summer 2015
      • Alumni Map
    • Applicants
      • EMIG
        • EMIG EMS Ride-Alongs
      • Residency Applicants
      • MS4 Clerkship Applicants
      • Wellness
        • Resiliency Toolbox
        • Mental Health Resources
        • New York City things-to-do
          • Viewing.NYC
        • Free Write May 2017
        • Other Wellness Information
        • Having Children During Residency – Pregnancy tips for new moms and dads
    SinaiEM