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Life-threatening asthma exacerbation — RCPSC EM MCQ

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ModerateRespiratory emergenciesLife-threatening asthma exacerbationRCPSC EM

A 31-year-old with known asthma arrives by ambulance after three hours of worsening wheeze. She is speaking single words, respiratory rate is 34/min, oxygen saturation is 89% despite high-flow oxygen, and peak flow is unobtainable. She has diffuse wheeze and marked accessory muscle use. What is the most appropriate initial management?

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Correct answer: E — Give repeated inhaled salbutamol/ipratropium, systemic corticosteroid and IV magnesium while preparing for possible intubation

Severe life-threatening asthma requires immediate high-dose inhaled bronchodilators, systemic steroids, oxygen, IV magnesium and senior preparation for ventilatory support if fatigue or deterioration develops.

Reference: CAEP asthma resources; Canadian Thoracic Society asthma guidance; ACLS