Miss Winters, age 25, comes to the emergency department with severe wheezing, dyspnea, and anxiety. She was in the ED only 6 hours ago with an acute asthma attack, which resolved with nebulized albuteral treatments.
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-Admits to use of albuterol inhaler several times weekly for the last few months
-Asthma symptoms occasionally awaken her at night (about 3 times a week), and she has cancelled several outings with her family due to her symptoms
-Can now only speak in one to three word sentences
-Is allergic to cigarette smoke
-Began to experience increased shortness of breath and chest tightness when she returned home
-Used albuterol inhaler repeatedly at home without relief
-History of pruritic skin lesions that have come and gone since childhood.
-Using accessory muscles to breath
-Audible inspiratory and expiratory wheezing to auscultation with no air movement in lower lobes of l
-HR = 126/min; Resp = 40/min
-Areas of dry, scaling skin in antecubital areas bilaterally with evidence of scratching
ABGs: PO2 = 80 mm Hg
PCO2 = 35mm Hg
HCO3 = 24 mEq/L
pH = 7.48
PEFR: 150 L/min (Personal best: 400 L/min)
Continuous pulse oximetry: 82-85
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