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Life-Threatening Asthma — RACP Adult Medicine MCQ

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HardRespiratoryLife-Threatening AsthmaRACP Adult Medicine

A 28-year-old with life-threatening asthma has received oxygen, repeated inhaled salbutamol plus ipratropium, systemic corticosteroid and IV magnesium. She is now drowsy with a silent chest and rising PaCO2. What is the next priority?

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Correct answer: BProceed to controlled intubation and ventilation by the most experienced available airway team while continuing resuscitation

The best answer is “Proceed to controlled intubation and ventilation by the most experienced available airway team while continuing resuscitation”. Drowsiness, a silent chest and rising carbon dioxide indicate impending ventilatory failure. Pharmacological adjuncts must not delay expert airway control and intensive-care management. Aminophylline and systemic beta-agonists add toxicity and have uncertain incremental benefit after maximal inhaled treatment; repeated magnesium is not a recommended rescue sequence, and adrenaline is reserved for a relevant anaphylactic mechanism.

Reference: Australian Asthma Handbook: Acute asthma in adults and adolescents: https://www.asthmahandbook.org.au/acute-asthma/adults-and-adolescents/managing-acute-asthma-in-adults-and-adolescents-in-the-ed