12-07-2016, 01:19 AM
A 35-year-old woman is evaluated in an urgent care center for an acute exacerbation of asthma. She has a history of frequent asthma exacerbations requiring unscheduled visits; however, between these exacerbations, her examination and pulmonary function studies have been unremarkable. Her current medications are inhaled budesonide and inhaled albuterol.
On physical examination, she is in moderate distress with audible inspiratory and expiratory wheezing. Temperature is 37.0 °C (98.6 °F), pulse rate is 110/min, and respiration rate is 26/min. Monophonic inspiratory and expiratory wheezing is heard predominantly in the central lung fields. Other than tachycardia, the cardiac examination and remainder of the physical examination are normal.
She receives intravenous methylprednisolone and three nebulized albuterol-ipratropium bromide treatments. On follow-up evaluation 1 hour later, she still has wheezing, tachycardia, and tachypnea and is in moderate respiratory distress. Oxygen saturation is 96% breathing ambient air.
Which of the following is the most appropriate next step in management?
A Chest radiograph
B Intravenous magnesium sulfate
C Laryngoscopy
D Levofloxacin
On physical examination, she is in moderate distress with audible inspiratory and expiratory wheezing. Temperature is 37.0 °C (98.6 °F), pulse rate is 110/min, and respiration rate is 26/min. Monophonic inspiratory and expiratory wheezing is heard predominantly in the central lung fields. Other than tachycardia, the cardiac examination and remainder of the physical examination are normal.
She receives intravenous methylprednisolone and three nebulized albuterol-ipratropium bromide treatments. On follow-up evaluation 1 hour later, she still has wheezing, tachycardia, and tachypnea and is in moderate respiratory distress. Oxygen saturation is 96% breathing ambient air.
Which of the following is the most appropriate next step in management?
A Chest radiograph
B Intravenous magnesium sulfate
C Laryngoscopy
D Levofloxacin