EpistemisNasal flaring in adults with respiratory failure
Specialty: Respiratory.
Why it occurs
- Severe bilateral pneumonia with acute respiratory distress syndrome (ARDS) (nasal flaring is a physical sign of extreme respiratory effort that reflects activation of the nasal muscle to decrease upper airway resistance during forced inspiration)
- Massive pulmonary thromboembolism with imminent cardiovascular collapse
- Near-fatal asthma attack or status asthmaticus (muscle exhaustion with maximal recruitment of all accessory respiratory muscles, including facial muscles)
- Septic or cardiogenic shock with extreme metabolic acidosis (maximal central stimulation of the respiratory center to induce rapid deep respiratory compensation).
Initial workup
Immediate vital signs evaluation; Urgent analytical arterial blood gas; continuous pulse oximetry; 12-lead electrocardiogram; Portable chest x-ray; Blood analysis with lactate, electrolytes and cardiac biomarkers.
red flags
Presence of nasal flaring in the adult (indicates extreme clinical severity and imminent exhaustion of ventilatory reserve), palpable central cyanosis, paradoxical pulsus (drop in systolic blood pressure >10 mmHg during inspiration), profound alteration of the state of consciousness or pulmonary auscultatory silence.
Standard management
- Management of immediate aggressive ventilatory support — high-flow oxygen therapy or endotracheal intubation according to criteria
- Methylprednisolone — 80-125 mg intravenously immediately in severe obstructive or inflammatory pathology
- Furosemide (40 mg intravenously if respiratory failure is due to acute cardiogenic lung edema).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 4
- Treatment options
- 3