A 28-year-old female with a history of severe asthma is experiencing an acute exacerbation. She is sitting upright, speaking in single words, and has audible wheezing. Her peak expiratory flow rate (PEFR) is 40% of her personal best. What is the MOST appropriate next intervention after administering a bronchodilator?
- APrepare for intubation.
- BEncourage slow, deep breathing exercises.
- CAdminister magnesium sulfate intravenously.
- DReassess PEFR and consider additional bronchodilator or steroids.
Show answer & explanationAnswer & explanation
Correct answer: D. Reassess PEFR and consider additional bronchodilator or steroids.
The patient is in a severe asthma exacerbation (PEFR 40% of personal best, speaking in single words). After initial bronchodilator, reassessment is crucial. If symptoms persist and PEFR remains low, additional bronchodilators, systemic corticosteroids, and potentially magnesium sulfate are indicated. Preparing for intubation is premature unless she shows signs of impending respiratory arrest.
Why the other options are wrong
- A. Intubation is a last resort for impending respiratory arrest, not the immediate next step after initial bronchodilator.
- B. Deep breathing exercises are unlikely to effectively reverse severe bronchospasm.
- C. Magnesium sulfate is a valid treatment for severe asthma but typically follows initial bronchodilators and steroids, or as part of a continued aggressive management plan after reassessment.
Severe Asthma Exacerbation Management
Management of severe asthma exacerbation involves rapid administration of bronchodilators, oxygen, and systemic corticosteroids. Reassessment of clinical status and objective measures like PEFR is critical to guide further therapy, which may include additional bronchodilators, magnesium sulfate, or consideration of advanced airway.
- PEFR < 50% of personal best indicates severe exacerbation.
- Initial treatment: oxygen, inhaled SABA (albuterol), ipratropium, systemic steroids.
- Reassessment guides further treatment (repeat SABA, magnesium, intubation if respiratory arrest imminent).
Memory trick: Bronchodilate, reassess, then escalate or stabilize the stress.