A 35-year-old woman with persistent severe asthma is being seen in the ED. On a previous admission, she required mechanical ventilation and was transferred to the intensive care unit (ICU) to treat an asthmatic exacerbation. For the past week, she has increased her use of Beta-2 agonist as rescue medication by 6 to 8 times and has night-time exacerbations every evening. On physical examination, he is in acute respiratory distress with nasal flaring and a quiet chest with very distant wheezing.
An ABG drawn on 30% oxygen shows a pH of 7.35, P ACO2 of 42 mmHg, P AO2 of 89 mmHg, and bicarbonate (HCO 3 ) of 23 mEq/L. Peak exploratory flow rates are below 40% of the patient's predicted range. Her respiratory rate is 30 breaths/minute, heart rate is 110 beats/minute, and blood pressure is 150/78 mmHg with a pulsus paradoxicus of 10 mmHg. What is the next most important step in the…
