A 3- year old boy is brought to the casualty-by his mother with progressive shoness of breath for 1 day. The child has history of bronchial asthma. On examination, the child is blue, gasping and unresponsive What will you like do first?

This child is showing features of acute severe asthma. In patients with acute severe asthma there is inadequate minute ventilation and V/Q mismatching as a result they will almost be hypoxic and should immediately receive supplemental humidified oxygen immediately to maintain saturation more than 90%. Following oxygen they should be given: Sho acting beta2 agonists(nebulization or IV) S.c epinephrine or terbutaline IV steroids If respiratory failure sets in invasive ventilation might be required. Signs of acute severe asthma includes: Dyspnea at rest Inability to speak Use of accessory muscles of respiration Cyanosis Silent chest Altered level of consciousness Pulsus paradoxus Ref: CURRENT Diagnosis & Treatment: Pediatrics, 21e chapter 14, By Joseph A. Albietz III, MD