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Acute severe asthma — DIPIMC MCQ

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ModerateMedical EmergenciesAcute severe asthmaDIPIMCDipIMC

A known asthmatic is acutely breathless with a respiratory rate of 32, unable to complete sentences, a peak flow of 40% of best, an SpO2 of 91% and a chest that is becoming quiet.

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

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Correct answer: C — Oxygen-driven nebulised salbutamol and ipratropium, steroids and intravenous magnesium, with escalation

Explanation lettering: E = shown as C · C = shown as E

Features such as an SpO2 below 92%, exhaustion and a quietening chest indicate life-threatening asthma, managed with oxygen-driven nebulised bronchodilators, systemic steroids, intravenous magnesium and early senior help. Adrenaline (D) is not first-line in asthma unless there is anaphylaxis or arrest. Oral salbutamol (A) is inadequate in a severe attack. Grade the severity and escalate treatment to match it.

Reference: BTS/SIGN/NICE asthma guidance; JRCALC