An agitated and nervous 24-year-old woman has had severe wheezing and shortness of breath for 2 days. After receiving oxygen, steroids, and salbutamol (Ventolin) in the emergency room, her breathing improves. She is still wheezing and now feels tremulous and anxious with a pulse of 110/min and respirations 30/min. Arterial blood gases on oxygen reveal a pH of 7.40, PO2 340 mm Hg, PCO2 40 mm Hg, and bicarbonate of 24 mEq/L. She is hospitalized for further treatment. Which of the following treatments or medications should be avoided in her?
High-Yield Explanation
Tranquilizers and sedatives should be avoided in prolonged asthma attacks. Bronchodilators, fluids, aminophylline, and steroids may be used. In acute situations, IV glucocorticoids are frequently used. Results of therapy should be monitored in an objective manner, with peak expiratory flow rates or FEV1. In acute asthmatic attacks, hypocarbia is usual on blood gas analysis. Normal or elevated PaCO2 is a bad sign and requires intensive monitoring and aggressive treatment.