A 29-year-old woman presents to the emergency department with 2 days of worsening shortness of breath and wheeze. She has asthma and was admitted to the ICU for an exacerbation 2 years ago. She ran out of her controller inhaler 2 weeks ago and has used her salbutamol inhaler every 2 hours over the past day without relief. She has no known drug allergies. On examination she is anxious, uses accessory muscles, and has diffuse expiratory wheezing. Peak expiratory flow is 45% of predicted and chest x-ray is normal. She is given repeated salbutamol and ipratropium by spacer, oral prednisone, and controlled oxygen.
| Heart rate | 122/min |
| Respiratory rate | 34/min |
| Temperature | 36.9 °C |
| O2 saturation | 89%, room air |
| Blood pressure | 128/78 mm Hg |
Question 1 of 30
After 1 hour of treatment she still speaks in short phrases. Respiratory rate is 28/min, oxygen saturation is 91% on low-flow oxygen, and peak expiratory flow remains 45% of predicted. She is alert and her chest is not silent. Which one of the following is the most appropriate next step in management?
Select 1. (0 / 1 selected)
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