Life-threatening asthma — DipIMC MCQ

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EasyMedical EmergenciesLife-threatening asthmaDipIMC

A 19-year-old asthmatic is found sitting upright at a bus stop. He is exhausted, too breathless to speak, saturations 86% and there is a silent chest. What is the most appropriate immediate action?

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Correct answer: E — Give high-flow oxygen and nebulised bronchodilators urgently

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

C is correct: Silent chest, exhaustion and hypoxia indicate life-threatening asthma needing immediate oxygen-driven nebulised treatment and escalation. A is less suitable because it does not address the discriminator in the vignette; B is less suitable because it moves the patient before the decisive threat or destination issue is addressed; D is less suitable because it moves the patient before the decisive threat or destination issue is addressed; E is less suitable because it does not address the discriminator in the vignette. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; Resuscitation Council UK; NICE guidance where applicable