Which of the following would you recommend as initial therapy for a patient admitted to the emergency department with acute airway obstruction (wheezing, cough, dyspnea, peak expirato-ry flow rate [PEFR] <60% predicted)?
1. Assess dose-response of metered dose inhaler (MDI) albuterol (up to 12 puffs).
2. Provide up to three small-volume jet nebulizer (SVN) treatments with albuterol every 20 min.
3. Immediately begin continuous albuterol therapy at 15 mg/hr.
a. 1 or 2 only
b. 1 or 3 only
c. 2 or 3 only
d. 1, 2, and 3
ANS: A
A patient with acute airway obstruction (wheezing, cough, dyspnea, and PEFR <60% of pre-dicted value) would receive up to three SVN treatments with a standard dose of albuterol, re-peated at 20-min intervals, or four puffs of pressurized MDI albuterol with a holding chamber (up to 12 puffs).
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