Podcast 992: Fentanyl for Asthma

Podcast 992: Fentanyl for Asthma

Contributor: Alec Coston, MD

Educational Pearls:

  • BiPAP is often effective in severe asthma, but many patients struggle with mask tolerance due to intense air hunger–driven anxiety, often compounded by hypoxia.

  • Benzodiazepines are commonly used for anxiety, but they can depress respiratory drive, making clinical improvement difficult to interpret (a lower RR may reflect sedation rather than true physiologic improvement).

  • Low-dose fentanyl is a useful alternative when patients cannot tolerate BiPAP despite coaching.

    • Opioids blunt the perception of dyspnea and are well established for treating air hunger.

    • When carefully titrated, fentanyl provides anxiolysis without significant respiratory suppression.

    • It is rapidly titratable (e.g., 25 mcg IV every 5 minutes).

  • Evidence primarily comes from palliative and oncology literature, but growing clinical experience supports its use in severe asthma to improve BiPAP tolerance.

  • Failure of fentanyl should prompt escalation to ketamine, often signaling impending need for intubation.

References

  1. Pang GS, Qu LM, Tan YY, Yee AC. Intravenous Fentanyl for Dyspnea at the End of Life: Lessons for Future Research in Dyspnea. Am J Hosp Palliat Care. 2016 Apr;33(3):222-7. doi: 10.1177/1049909114559769. Epub 2014 Nov 25. PMID: 25425740.

Summarized and edited by Meg Joyce, MS2

Donate: https://emergencymedicalminute.org/donate/

Join our mailing list: http://eepurl.com/c9ouHf

Jaksot(1145)

Episode 951: Pediatric Febrile Seizures

Episode 951: Pediatric Febrile Seizures

Contributor: Taylor Lynch, MD Educational Pearls: Pediatric febrile seizures are defined as seizures that occur between the ages of six months to five years in the presence of a fever greater than o...

7 Huhti 20256min

Episode 950: Ultrasound Pulse Check During Cardiac Arrest

Episode 950: Ultrasound Pulse Check During Cardiac Arrest

Contributor: Aaron Lessen, MD Educational Pearls: Point-of-care ultrasound (POCUS) is used to assess cardiac activity during cardiac arrest and can identify potential reversible causes such as peric...

31 Maalis 20252min

Episode 949: Hoover's Sign

Episode 949: Hoover's Sign

Contributor: Travis Barlock, MD Educational Pearls: What is Hoover's sign used to identify? This physical exam maneuver differentiates between organic vs. functional (previously known as psychogenic...

24 Maalis 20251min

Episode 948: CYP Inducers and Inhibitors

Episode 948: CYP Inducers and Inhibitors

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: CYP enzymes are responsible for the metabolism of many medications, drugs, and other substances CYP3A4 is responsible for the majorit...

17 Maalis 20253min

Episode 947: Hypercapnia

Episode 947: Hypercapnia

Educational Pearls: Physiologic stimulation of ventilation occurs through changes in levels of: Arterial carbon dioxide (PaCO2) Arterial oxygen (PaO2) Hypercapnia is an elevated level of CO2...

10 Maalis 20253min

Episode 946: Time to Defibrillation

Episode 946: Time to Defibrillation

Contributor: Aaron Lessen, MD Educational Pearls: Quick background info Cardiac arrest is when the heart stops pumping blood for any reason. This is different from a heart attack in which the heart ...

3 Maalis 20252min

Episode 945: Ketorolac vs. Ibuprofen

Episode 945: Ketorolac vs. Ibuprofen

Contributor: Ricky Dhaliwal, MD Educational Pearls:  Ketorolac and ibuprofen are NSAIDs with equivalent efficacy for pain in the emergency department Oral ibuprofen provides the same relief as in...

24 Helmi 20253min

Episode 944: Colchicine Overdose

Episode 944: Colchicine Overdose

Contributor: Aaron Lessen, MD Educational Pearls: Colchicine is most commonly used for the prevention and treatment of gout There is research investigating the anti-inflammatory and cardioprotect...

17 Helmi 20253min

Suosittua kategoriassa Tiede

tiedekulma-podcast
rss-mita-tulisi-tietaa
rss-poliisin-mieli
docemilia
radio-antro
rss-duodecim-lehti
rss-ammamafia
rss-sosiopodi
utelias-mieli
ihanat-ipanat
mielipaivakirja
filocast-filosofian-perusteet
rss-bios-podcast
rss-tiedetta-vai-tarinaa