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Acute severe asthma — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsAcute severe asthmaSCE Acute Medicine

A 29-year-old woman is assessed on the acute medical unit. She is unable to complete sentences, has widespread wheeze and a peak flow of 38% predicted. Oxygen saturation is 91% on air and there is no focal chest sign. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Give nebulised salbutamol driven by oxygen

Give nebulised salbutamol driven by oxygen is the best answer because this is acute severe asthma and immediate oxygen-driven high-dose beta-agonist treatment is required alongside steroids and reassessment. Give intravenous calcium gluconate immediately 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: A normal or silent chest in severe asthma is a danger sign rather than reassurance.

Reference: BTS/SIGN asthma guideline; BNF