Red flags
- Silent chest, cyanosis, exhaustion
- SpO₂ <92%, normal or ↑ PaCO₂
- Altered consciousness
First steps
- ABCDE + O₂ to SpO₂ 94-98%
- Nebulised salbutamol 5 mg + ipratropium 500 mcg back-to-back
- Prednisolone 40-50 mg PO or hydrocortisone 100 mg IV
- IV access
Key investigations
- Peak flow (compare with best/predicted)
- SpO₂, ABG if not improving
- CXR to exclude pneumothorax
Differentials
- COPD exacerbation
- Anaphylaxis
- Pneumonia
- PE
- Cardiac wheeze
Initial management
- Magnesium sulfate 2 g IV over 20 min if severe/life-threatening
- IV salbutamol/aminophylline (specialist)
- NIV/intubation if exhausted, silent chest, or rising CO2
- Admit to HDU/ICU
Referral
- Respiratory / ICU
AI clinical assessment
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This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
