Question

A 45-year-old man with known asthma presents to the emergency department with increasing shortness of breath and wheeze over 3 hours. He is speaking in phrases, respiratory rate is 26 breaths/min, oxygen saturation 92% on room air, pulse 110 beats/min and peak expiratory flow is 55% of predicted. There is widespread wheeze on auscultation. What is the most appropriate initial management?

Accepted Answer

Administer 4-12 puffs of salbutamol via pMDI and spacer plus oral prednisolone 50 mg, and titrate further bronchodilator as needed

Answer

Give a single nebulised salbutamol treatment and discharge if he feels better

Answer

Start intravenous salbutamol infusion immediately without inhaled therapy

Answer

Commence high-dose intravenous hydrocortisone and observe before using bronchodilators

Answer

Withhold oxygen unless saturation drops below 88%

Practice question