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Life-threatening asthma exacerbation — ABIM Board MCQ

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HardPulmonary/Critical CareLife-threatening asthma exacerbationABIM Board

A 29-year-old woman with asthma is brought to the ED after multiple albuterol treatments. She is using accessory muscles, speaks in words, and is drowsy. Peak expiratory flow is 25 percent predicted. ABG shows pH 7.30, PaCO2 46 mm Hg, and PaO2 70 mm Hg on oxygen. Which of the following is the most appropriate management?

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

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Correct answer: E — Prepare for endotracheal intubation while giving aggressive bronchodilator and steroid therapy

Drowsiness, exhaustion, rising or normal PaCO2 despite tachypnea, and severe airflow limitation indicate impending respiratory failure in acute severe asthma. Intubation planning should not delay nebulized beta agonists, ipratropium, corticosteroids, and magnesium when appropriate.

Reference: GINA Asthma Strategy; NHLBI Asthma Guidance