A fictional 27-year-old with asthma remains breathless after repeated reliever treatment. Speech is limited, respiratory effort is falling and air entry is now barely audible.
Listen for the assumption.
The wheeze has become quieter, but the patient looks exhausted and the peak flow cannot be performed.
Does less wheeze represent improvement here?
No. Poor air movement, exhaustion and inability to speak or perform peak flow indicate life-threatening deterioration.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Oxygen saturation remains low despite initial oxygen
- Arterial carbon dioxide is no longer low
- Respiratory effort and conscious level are deteriorating
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
I want repeated severity assessment, treatment times and response, not a single peak-flow value.
Correct. Continue the acute pathway while preparing for ventilatory support; sedation or transfer without appropriate expertise can be hazardous.
I will state the life-threatening features and the airway/critical-care plan explicitly.
What must remain explicit.
- Use the current local acute-asthma pathway.
- Repeat observations and blood gases according to clinical need.
- Escalate exhaustion, altered consciousness, silent chest, worsening hypoxia or rising carbon dioxide immediately.
Where reasoning fails.
- Equating less wheeze with recovery
- Waiting for peak flow when the patient cannot perform it
- Late critical-care referral
Life-threatening asthma with [features], treatments at [times], objective response [trend], gas results [trend] and current airway/critical-care plan [details].
Which findings would prompt you to call critical care before any blood-gas result returns?