A 29-year-old woman presents to a Canberra ED, triage category 1, with severe asthma. RR 34, HR 138, SpO2 90% on oxygen. She is exhausted, speaking

Question

A 29-year-old woman presents to a Canberra ED, triage category 1, with severe asthma. RR 34, HR 138, SpO2 90% on oxygen. She is exhausted, speaking single words, with silent chest areas. VBG shows pH 7.19 and pCO2 68 mmHg despite nebulised bronchodilators. What is the most appropriate management?

Accepted Answer

Escalate to senior-led intubation while continuing bronchodilators

Answer

Arrange outpatient spirometry

Answer

Start oral antibiotics as primary therapy

Answer

Give low-dose inhaled steroid and observe

Answer

Discharge after peak flow improves slightly

Life-threatening asthma — ACEM Fellowship MCQ

A 29-year-old woman presents to a Canberra ED, triage category 1, with severe asthma. RR 34, HR 138, SpO2 90% on oxygen. She is exhausted, speaking single words, with silent chest areas. VBG shows pH 7.19 and pCO2 68 mmHg despite nebulised bronchodilators. What is the most appropriate management?