Management 2
After 30 minutes, including 3 back-to-back salbutamol 5 mg nebulisers, one with 0.5 mg ipratropium; she remains very breathless and is still struggling or perhaps even worse
Feedback:
- Call a senior physician for immediate assistance and make it clear that you need their help urgently
- This should not be a long phone call... This patient is critically unwell and has not responded to immediate appropriate therapy
- There are further therapeutic options available such as intravenous magnesium, aminophylline, salbutamol etc but we would not expect a FY1 (or medical student...) to be guiding such therapy
- Repeat ABG (the patient may now have a rising CO2 which would be very worrying and require urgent critical care review)
- Stay with the patient until further help arrives
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Even if the patient is breathless and very distressed DO NOT prescribe anxiolytics (such as diazepam) or opiates as this could lead to rapid ventilatory failure
