acute asthma exacerbation ...next step q

[tyagee]

A 23-year-old woman with a long history of asthma and previous exacerbations requiring intubation is evaluated in the emergency department for a 2-day history of increasing wheezing and dyspnea after the onset of a sore throat. She has a cough productive of small amounts of whitish mucus with some plugs. She has no fever or chills and says that she has used her albuterol inhaler many times in the past day. She had been taking montelukast daily but had not been using her corticosteroid inhaler because she had previously felt well.

On physical examination, she is alert and cooperative but in severe respiratory distress; the blood pressure is 160/80 mm Hg, heart rate is 140/min, and respiration rate is 36/min. She is using accessory muscles of breathing. She has nasal flaring, and chest examination reveals diffuse inspiratory and expiratory wheezes.

Peak expiratory flow rate is 110 L/min; leukocyte count is 16,500/μL. Measurement of arterial blood gases shows a pH of 7.32, PCO2 of 44 mm Hg, and PO2 of 76 mm Hg with the patient breathing oxygen, 5 L/min by nasal cannula. Chest radiograph shows hyperinflation but is otherwise normal.

Intravenous corticosteroid therapy is begun.

Which of the following is the most appropriate next step in this patient's management?

A An anticholinergic agent and a short-acting β-agonist
B Helium combined with oxygen (Heliox)
C Intravenous or inhaled magnesium sulfate
D Prompt intubation

[bisho]

Ans A the question start with steroid before giving bronchodilator
Mg could be add if no response

[tyagee]

can i get more expln to your reason, ya its the correct ans. patient is having high PaCO2 with low PaO2, isnt that an indication to intubate ? anything less than 80 PaO2 should mean intubate.???

[Novobiocin]

A An anticholinergic agent and a short-acting β-agonist.
They have not been given yet and they provide immediate relief while steroids takes at least 4 hours.
Once anticholinergic agent and a short-acting β-agonist have been tried then only other options are to be considered.

[hishamsalahuddi]

D she is in respiratory acidosis and needs immediate intubation

[tyagee]

Originally Posted by hishamsalahuddi

D she is in respiratory acidosis and needs immediate intubation

i am of the same thought.

please anyone come ahead, and solve this dilemma? patient has indications for intubation ... so why not intubate ?

[bisho]

Originally Posted by tyagee

i am of the same thought.

please anyone come ahead, and solve this dilemma? patient has indications for intubation ... so why not intubate ?

[QUOTE]Once anticholinergic agent and a short-acting β-agonist have been tried then only other options are to be considered.[QUOTE]