Nebulised bronchodilator oxygen drive — DipIMC MCQ

Correct answer: D — Use oxygen-driven nebulised salbutamol and reassess

Option D is correct because Severe asthma with hypoxaemia requires high-concentration oxygen and inhaled bronchodilator therapy, so an oxygen-driven nebuliser is appropriate. A metered-dose inhaler alone is less suitable in a patient unable to speak and with low saturations. Early reassessment is crucial because exhaustion, silence on auscultation or falling consciousness signals impending arrest. Option E is less appropriate because oxygen may be supportive, but it does not address the defining time-critical problem first; option C is less appropriate because vascular access is useful, but it should not delay the immediate priority. Option A is less appropriate because it is plausible in a different scenario but suboptimal for the features described; option B is less appropriate because delay would increase clinical risk. Clinical pearl: in DipIMC-style questions, the best answer is the intervention that changes outcome earliest in the pre-hospital phase.

Reference: JRCALC Guidelines; BTS/SIGN British Guideline on the Management of Asthma