An 11 year old girl known asthmatic is brought to the Casualty Department in a confused state



Question:
An 11 year old girl known asthmatic is brought to the Casualty Department in a confused state. On examination she appears distressed and unwilling to lie down. Ausculatation of her chest does not reveal any wheezing. It is noted that she has marked sternal retraction and is inable to speak in more than monosyllables. There is a lowering in the systemic systolic blood pressure by 25mmHg during inspiration. Appropriate management should include
a) refer to an ENT specialist
b) emergency treatment and immediate transfer to intensive care unit
c) iv theophylline
d) Nebulised ipratropium bromide
e) Single dose 1 ml 0.5% salbutamol


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