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Life-threatening asthma — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsLife-threatening asthmaSCE Acute Medicine

A 58-year-old man presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show silent chest, exhaustion and rising PaCO2 indicate impending respiratory arrest. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Call critical care and prepare for intubation while continuing emergency asthma treatment

The key discriminator is that silent chest, exhaustion and rising PaCO2 indicate impending respiratory arrest, which makes Call critical care and prepare for intubation while continuing emergency asthma treatment the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BTS/SIGN Asthma Guideline