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Which is the best initial management?
On reassessment, she has deteriorated with RR 35, sats 91% and unable to speak in full sentences. She has HR 127. She is uncooperative with peak flow testing. She appears confused and is not responding to her Mum.
Which is the most concerning sign?
Despite back to back nebs of ipratropium and salbutamol and oral steroids, she doesn’t improve.
Which is the most appropriate management step to take next?