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A 33-year-old woman is evaluated in the emergency department for a 6-hour history of worsening asthma symptoms. Her medications include albuterol and an inhaled corticosteroid. She is treated with intravenous corticosteroids and albuterol. After 4 hours of treatment, she remains symptomatic and can speak only one to two words between breaths. On physical examination, she appears uncomfortable and tired. Temperature is 36.8°C (98.2°F), blood pressure is 150/90 mm Hg, heart rate is 124/min, and respiration rate is 32/min. Oxygen saturation by pulse oximetry is 92% with oxygen 2 L/min by nasal cannula. Lung examination reveals poor air movement and diffuse expiratory wheezes. Results of arterial blood gas studies: pH, 7.2; PCO2, 45 mm Hg (6.0 kPa); PO2, 70 mm Hg (9.3 kPa). Peak flow is 30% of best performance. Which of the following is the most appropriate management for this patient?
(A) Admission to the hospital ward
(B) Intubation and mechanical ventilation
(C) Continued therapy in the emergency department
(D) Discharge home
A 33-year-old woman is evaluated in the emergency department for a 6-hour history of worsening asthma symptoms. Her medications include albuterol and an inhaled corticosteroid. She is treated with intravenous corticosteroids and albuterol. After 4 hours of treatment, she remains symptomatic and can speak only one to two words between breaths. On physical examination, she appears uncomfortable and tired. Temperature is 36.8°C (98.2°F), blood pressure is 150/90 mm Hg, heart rate is 124/min, and respiration rate is 32/min. Oxygen saturation by pulse oximetry is 92% with oxygen 2 L/min by nasal cannula. Lung examination reveals poor air movement and diffuse expiratory wheezes. Results of arterial blood gas studies: pH, 7.2; PCO2, 45 mm Hg (6.0 kPa); PO2, 70 mm Hg (9.3 kPa). Peak flow is 30% of best performance. Which of the following is the most appropriate management for this patient?
(A) Admission to the hospital ward
(B) Intubation and mechanical ventilation
(C) Continued therapy in the emergency department
(D) Discharge home
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