Bronchodilators: Frequent albuterol nebs (2.5 mg q20 min) or continuous neb (10-15 mg/hr).Intubated asthmatic basic medication package: Glycopyrrolate (0.2 mg IV less evidence).Terbutaline (0.25 mg SC, q15-30 min x3 doses PRN).Start 5 mcg/min, titrate 1-10 mcg/min (peripheral IV is fine).Bradycardia related to dexmedetomidine.Unable to tolerate inhaled bronchodilators (re: coughing).(If wholly unable to tolerate BiPAP, may use high-flow nasal cannula or heliox 📖).May use small doses of opioid while waiting for dexmedetomidine to take effect, if severely dyspneic (e.g., fentanyl 25 mcg IV PRN).This may be helpful as an anxiolytic agent, even if the patient is able to tolerate the BiPAP mask. Start dexmedetomidine infusion at maximal rate (down-titrate as takes effect).Methylprednisolone 125 mg IV x1 (or equivalent steroid).

Ipratropium (may use 1.5 mg over first hour, then 0.5 mg nebulized q4-6 hr).

Stacked albuterol nebs (2.5-5 mg q20) or continuous neb (10-15 mg/hr).

Non-intubated asthmatic basic medication package:

“We're bagging because the vent keeps alarming”.General principles of ventilating an asthmatic.

Beware of asthma treatment pseudofailure.

Adding dead space to ventilator