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Severe asthma with poor response — DipIMC MCQ

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HardMedical EmergenciesSevere asthma with poor responseDipIMC

A 22-year-old with asthma has persistent wheeze after two oxygen-driven salbutamol nebulisers. SpO2 is 90%, respiratory rate 32/min, pulse 132/min, and peak flow is 28% predicted; IV access is established. What is the most appropriate drug/dose?

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Correct answer: A — Magnesium sulfate 2 g IV over 20 minutes

Life-threatening asthma with poor response to initial bronchodilator therapy may require IV magnesium in addition to oxygen, nebulised beta-agonist, ipratropium and steroids. Furosemide and GTN treat cardiogenic pulmonary oedema, not bronchospasm. Naloxone is for opioid toxicity and would not address severe asthma.

Reference: JRCALC Guidelines; BTS/SIGN asthma principles