A 35-year-old woman with persistent asthma is being presented at emergency. On a previous admission, she required mechanical ventilation and was transferred to the intensive care unit for treatment of an asthmatic exacerbation. For the past week, she has increased her use of beta-agonists as rescue medication by 6 to 8 times normal and has nighttime exacerbations every evening. On physical examination, she 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, PACO 2 42mm Hg, PAO 2 89mm Hg and bicarbonate (HCO 3 ) of 23 mEq/L.
Peak respiratory rate is 30 breaths/minutes, heart rate is 110 beats/min and regular, and blood pressure is 150.78 mm Hg with a pulsus paradoxicus of 10mm Hg. How best can this case be managed? What predictors are present that point to a high likelihood of intubation? Source:…
