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Severe asthma exacerbation — ABEM Board MCQ

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ModeratePulmonary emergenciesSevere asthma exacerbationABEM Board

A 19-year-old woman with asthma arrives speaking in one-word phrases. Triage acuity is ESI 2; BP 142/84 mm Hg, HR 132/min, RR 34/min, SpO2 89%. She has diffuse wheezing, accessory muscle use, and peak flow 35% predicted. She has already used albuterol repeatedly at home. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: E — Give continuous nebulized albuterol with ipratropium and systemic corticosteroids

Severe asthma exacerbation requires aggressive bronchodilation plus systemic corticosteroids; tachycardia is not a reason to withhold beta-agonists.

Reference: NAEPP asthma guidance; ACEP emergency airway guidance