A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath

Physical assessment reveals: pulse 102 beats/min, blood pressure 138/80 mm Hg, respiratory rate 25 breaths/min with accessory muscle use, and breath sounds are decreased with bilateral inspir-atory and expiratory wheezing with a prolonged expiratory phase. The peak expiratory flow rate is 100 L/min. The immediate action by the respiratory therapist should include which of the fol-lowing?
a. Intubate and mechanically ventilate.
b. Administer oxygen via nonrebreather mask.
c. Administer continuous bronchodilator therapy.
d. Initiate noninvasive positive pressure ven-tilation.

ANS: C
It would be inappropriate at this time to intubate this patient because he is still moving air, as ev-idenced by his respiratory rate and breath sounds (although he may be tiring). Noninvasive venti-lation is not appropriate for the same reasons. An arterial blood gas is necessary to establish the need for mechanical ventilation. This patient appears to be having an asthma exacerbation, as ev-idenced by his bilateral wheezing with a prolonged expiratory phase. The patient would probably benefit from oxygen therapy. However, the immediate problem and cause for alarm is his severe airflow obstruction, as evidenced by his breath sounds and peak expiratory flow rate (PEFR). Therefore, the most appropriate answer is to administer continuous bronchodilator therapy.