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Life-threatening asthma — RACP Paediatrics MCQ

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HardRespiratoryLife-threatening asthmaRACP Paediatrics

A 13-year-old with asthma is brought to ED after escalating salbutamol at home. He is exhausted, has a silent chest and oxygen saturation of 90% despite high-flow oxygen; venous blood gas shows pH 7.21 and CO2 62 mmHg. What is the most appropriate management?

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Correct answer: C — Urgent PICU escalation with intravenous bronchodilator therapy

A silent chest, exhaustion and hypercapnia indicate life-threatening asthma with impending respiratory failure, requiring senior/PICU escalation and intravenous therapy. Spirometry and routine discharge planning are inappropriate during an unstable attack. The pearl is that rising CO2 in acute asthma is a late and dangerous sign.

Reference: RCH Clinical Practice Guidelines: Acute asthma; Therapeutic Guidelines (eTG)