A 24yo male is admitted with acute severe asthma. Tx is initiated with 100% oxygen, nebulized salbutamol and ipratropium bromide nebulizers and IV hydrocortisone. Despite initial tx there is no improvement. Which is the next step in management?

The key is B. IV magnesium sulphate. [If patient not improving after 15-30 minutes of above

treatment:

• Continue oxygen and steroids.

• Use continuous nebulisation of salbutamol at 5-10mg/hour if specialist nebuliser available.

Otherwise give nebulised salbutamol 5mg every 15–30 minutes.

• Continue ipratropium 0.5mg 4–6 hourly until patient is improving.

IF PATIENT IS STILL NOT IMPROVING:

Consider IV magnesium sulphate 1.2–2g over 20 minutes].