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A 27-year-old female presents with acute asthma. She complains of worsening breathlessness and wheeze over the last 24 hours.

She has had previous hospital admissions with asthma but never to critical care. She has received salbutamol, ipratropium, hydrocortisone and magnesium. She is unable to complete sentences in one breath and is unable to perform a peak flow test. She appears exhausted.

An arterial blood gas is performed and her PaCO2 is 7.5 kPa.

Which of the following degrees of clinical severity does this patient fulfil?

(Please select 1 option)

Acute severe asthma

Life threatening asthma

Near fatal asthma Correct

Moderate exacerbation of asthma

Mild exacerbation of asthma

Explanation

The British Thoracic Society defines near fatal asthma as an attack with raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures.

A raised PaCO2 is an important sign that intubation may be required if the patient is not responding to maximum medical management.

Reference:

British Thoracic Society. Asthma Guideline.

Answer Statistics

1

6%

2

45%

3

50%

Times answered: 286