07-17-2008, 10:56 PM
A 20-year-old woman is evaluated in the emergency department for an acute exacerbation of asthma. The patient has a history of frequent visits to the emergency department and urgent care for asthma exacerbations. Between exacerbations she has normal pulmonary function.
On physical examination, she has inspiratory and expiratory wheezing and is in moderate discomfort. Oxygen saturation is 95% with the patient breathing room air. She is treated with methylprednisolone, 125 mg intravenously, and given three treatments with nebulized albuterol/ipratropium. Two hours later, she is still wheezing, anxious, and appears to be in moderate respiratory distress. Oxygen saturation on room air is 96%; pulse rate is 100/min and respiration rate 24/min. Chest radiograph shows low lung volumes.
Which of the following is the most appropriate management for this patient?
A Intravenous aminophylline
B Laryngoscopy
C Intravenous terbutaline
D Ceftriaxone/azithromycin
E Chest CT scan
On physical examination, she has inspiratory and expiratory wheezing and is in moderate discomfort. Oxygen saturation is 95% with the patient breathing room air. She is treated with methylprednisolone, 125 mg intravenously, and given three treatments with nebulized albuterol/ipratropium. Two hours later, she is still wheezing, anxious, and appears to be in moderate respiratory distress. Oxygen saturation on room air is 96%; pulse rate is 100/min and respiration rate 24/min. Chest radiograph shows low lung volumes.
Which of the following is the most appropriate management for this patient?
A Intravenous aminophylline
B Laryngoscopy
C Intravenous terbutaline
D Ceftriaxone/azithromycin
E Chest CT scan