Acute Severe Asthma

OSHITME approach

First 30 seconds

  1. 1Sit up, O₂ to SpO₂ 94–98%
  2. 2Salbutamol 5 mg neb back-to-back
  3. 3Ipratropium 0.5 mg neb
  4. 4Hydrocortisone 100 mg IV or prednisolone 40 mg PO

PEF 33–50%, RR ≥25, HR ≥110, unable to complete sentences. Life-threatening: PEF <33%, SpO₂ <92%, silent chest.

A

Airway

  • Patent? Talking? Stridor?
  • Suction, jaw-thrust, adjuncts, definitive airway if needed
B

Breathing

  • RR, SpO₂, auscultate, percuss
  • O₂ to target sats, NIV / intubate as required
C

Circulation

  • HR, BP, cap refill, JVP
  • 2× large-bore IV, bloods, monitor, ECG
D

Disability

  • AVPU/GCS, pupils, glucose, temp
E

Exposure

  • Full exposure, skin, rash, bleeding, lines, infection source
View flowchart algorithm
WardRound

WardRound

Clinical Decisions in Seconds