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Life-threatening asthma — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsLife-threatening asthmaSCE Acute Medicine

A 42-year-old man is assessed on the acute medical unit. He has asthma and arrives exhausted with a quiet chest. ABG on high-flow oxygen shows pH 7.21, PaCO2 8.1 kPa and PaO2 10.8 kPa. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: A — Request urgent senior critical care review

Request urgent senior critical care review is the best answer because hypercapnia and exhaustion in asthma indicate impending respiratory arrest and require urgent critical care involvement. Administer broad-spectrum intravenous antibiotics within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Rising carbon dioxide in asthma is a late and ominous sign.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-47-1