A patient arrives at the emergency clinic hyperventilating and complaining of wheezing and feeling tired.

A patient arrives at the emergency clinic hyperventilating and complaining of wheezing and feeling tired. The patient states that this is the first episode of breathing distress in over a week and that the shortness of breath has lasted for the past 6 hours. The patient’s PaCO2 is normal, although the breathing rate is increased. During the hour before coming to the emergency clinic, the patient used a SABA MDI six times without relief. The PEF is 40% of the patient’s personal best. What should the RCP do? Group of answer choices Advise the patient that coming to the emergency clinic is not necessary if the action plan is used. Treat the patient for severe exacerbation of asthma and impending respiratory failure. Give the patient a new asthma action plan and instructions on preventing triggers. Monitor the patient with spirometry and give the SABA medication time to take effect.

In this scenario, the patient is experiencing significant respiratory distress, as indicated by hyperventilation, wheezing, and an increased breathing rate, along with a peak expiratory flow (PEF) of 40% of their personal best despite using a Short-Acting Beta Agonist (SABA) MDI six times without relief. Given these details, the appropriate course of action for the respiratory care practitioner (RCP) would be to treat the patient for severe exacerbation of asthma and impending respiratory failure.

Rationale:
Severity of Symptoms: The patient has not achieved relief from using a SABA, which suggests that the current level of bronchospasm is significant.

PEF Measurement: A PEF of 40% of the personal best indicates a severe level of airway obstruction. This level suggests the patient is in a severe asthma exacerbation, which requires immediate intervention.

Clinical Indicators: The symptoms of hyperventilation, wheezing, and fatigue further support the need for urgent treatment.

Incorrect Options:
Advise the patient that coming to the emergency clinic is not necessary if the action plan is used: This is inappropriate given the acute distress the patient is experiencing.

Give the patient a new asthma action plan and instructions on preventing triggers: While education is important, it is not the priority in this emergency situation. Immediate treatment is necessary first.

Monitor the patient with spirometry and give the SABA medication time to take effect: Given the severity of the symptoms and the lack of relief from prior SABA use, monitoring alone is insufficient. Action must be taken to address the exacerbation.

Conclusion:
Treat the patient for severe exacerbation of asthma and impending respiratory failure is the correct choice, prioritizing immediate medical intervention to stabilize the patient’s condition. This may include administering systemic corticosteroids, nebulized bronchodilators, and potentially oxygen therapy to improve their respiratory status.