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HardEmergencyLife-threatening asthmaau-acemau-amc

A 30-year-old man with severe asthma presents with marked dyspnoea, is unable to speak full sentences, has a silent chest on auscultation and a rising PaCO2 on arterial blood gas. Oxygen saturation is 88% despite high-flow oxygen and nebulised salbutamol. What is the most appropriate immediate next step?

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