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Severe asthma with impending respiratory failure — RCPSC EM MCQ

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HardRespiratory emergenciesSevere asthma with impending respiratory failureRCPSC EM

CTAS 1: A 23-year-old with asthma is unable to speak more than single words. Vitals are HR 138, RR 34, SpO2 89% despite oxygen; PEF is 25% predicted. Chest exam reveals quiet breath sounds and VBG shows pH 7.24 with rising PaCO2. Salbutamol has started by nebuliser. What is the most appropriate initial management?

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

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Correct answer: C — Add ipratropium, systemic corticosteroid and intravenous magnesium while preparing for intubation

Life-threatening asthma needs aggressive bronchodilation, systemic steroids, magnesium, oxygenation and early airway planning. A rising carbon dioxide level is a late danger sign.

Reference: CAEP asthma resources; GINA; ACLS airway principles