hypoxic ischaemic encephalopathy, complicating cardiac arrest in the setting of asthma
AI-generated summary
A 48-year-old man with known asthma and high sensitivity to rye grass pollen died from hypoxic ischaemic encephalopathy following cardiac arrest during the November 2016 Melbourne thunderstorm asthma epidemic. He became acutely unwell at 7:20 pm with severe respiratory distress, family called '000' immediately and performed CPR. Ambulance response was timely in unprecedented circumstances; however, he sustained severe hypoxic brain injury and died 5 days later. Clinical lessons include: all asthmatics need written action plans and appropriate preventer medications (not just reliever); hay fever sufferers warrant allergy testing and preventive therapy; those at risk should remain indoors during TA warnings. The coroner noted his lack of documented asthma management plan, sub-optimal preventer use, and no documented hay fever treatment despite post-mortem evidence of high rye grass sensitisation.
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Specialties
emergency medicineparamedicinerespiratory medicineallergy and immunologypathology
High sensitisation to rye grass pollen (RAST 54.10 kUA/L)
Sub-optimal preventer medication use
No documented asthma action plan
Possible additional sensitisation to Alternaria mould
Exposure at window when thunderstorm occurred
Limited family communication regarding asthma status to treating doctors
Coroner's recommendations
Further research into the specific meteorological, biological and aerobiological factors that create thunderstorm asthma events to improve prediction and forecasting
Continued verification and development of the thunderstorm asthma forecasting system
Continuation of DHHS public awareness campaigns, asthma action plan promotion, and education regarding the hay fever-thunderstorm asthma link
Further medical and allied health education encouraging hay fever sufferers to undergo allergy testing and develop specific management plans
Community education to remain indoors with windows shut and turn off evaporative cooling during thunderstorm asthma warnings
Highlight the outstanding issue regarding provision of estimated ambulance arrival times to callers to enable informed decision-making about alternative transportation during surge events
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