Image Challenge

Which is the most effective medication in the management of an acute asthma exacerbation?

Children who use rescue medications more than ___ and experience nighttime symptoms more than ____, maybe inadequately controlled:

Which of the following is an ominous sign in an acute asthma exacerbation?

Which finding in an asthmatic is most likely to have pneumonia on a Chest X ray?

The following finding on a Chest X Ray of an asthmatic are indications to start antibiotics:

The following are side effects of inhaled beta agonist therapy, except:

Single dose of dexamethasone is not as effective as 5 day course of prednisone:

IV methylprednisone is more potent than oral prednisolone

Which of the following is a true statement:

A 12-year-old girl with poorly controlled asthma is brought to the emergency department with wheezing, cough, and dyspnea. She has been seen in the emergency department 6 times in the last year and required admission to the hospital on 4 of these occasions. During 2 episodes, she required admission to the intensive care unit with oxygen or noninvasive ventilatory support. She is nonadherent with prescribed inhaled corticosteroid/long-acting β-agonist and leukotriene inhibitor medications. Her usual triggers are weather changes and viral illness.

She has been using her short-acting β-agonist at a dose of 4 inhalations every 1 to 2 hours for the last 8 hours. She reports that her hands are shaking and her heart is racing.

She is spontaneously breathing but tachypneic and in moderate respiratory distress. She has a heart rate of 160 beats/min, respiratory rate of 44 breaths/min, and oxygen saturation of 95% in room air. Accessory muscles are used in respiratory effort, with retractions noted at suprasternal, subcostal, and substernal sites. Auscultation of the chest reveals no wheezing, crackles, or rhonchi. A radial pulse cannot be palpated during auscultation of cardiac sounds, and systolic blood pressure decreases by 20 mm Hg during inspiration. You have initiated therapy with continuous albuterol at 15 mg/h. The patient has just received prednisone 60 mg orally and intravenous magnesium sulfate.

Arterial blood gas tests reveal a pH of 7.34 and a pCO₂ of 36 mm Hg.

Of the following, the MOST appropriate next step in therapy is to