A 30-year-old gravida 2 para woman 1001 at 36 weeks of gestation presents to you with shortness of breath and wheezing for the past 30 minutes. Her medical history is significant for moderate persistent asthma, which has worsened over this pregnancy. She has used her albuterol rescue inhaler several times already with no improvement in her breathing. She is having difficulty answering questions and is using accessory muscles of respiration.
Her initial vital signs are: temperature 37 °C, heart rate 110 beats/minute, blood pressure 130/70 mm Hg, respiratory rate 24 breaths/minute, and oxygen saturation 90% on room air. Her physical examination is notable for diffuse wheezes and poor air movement. Fetal heart tracing (FHT) is in the 150s with minimal variability but no decelerations.
She is started on 100% oxygen via a non-rebreather mask and given an albuterol nebulizer treatment.
Her vital signs are reassessed and are: temperature 37 °C, heart rate 115 breaths/minute, blood pressure 120/70 mm Hg, respiratory rate 18 breaths/minute, and oxygen saturation 92% on a 100% non-rebreather mask.
An arterial blood gas (ABG) sample is drawn and reveals the following:
pH: 7.38
PaCO2: 40 mm Hg
PaO2: 65 mm Hg
HCO3-: 23 mEq/L
FHT is in the 140s with minimal variability and late decelerations. The patient is showing signs of fatigue but is still in respiratory distress.
What is the most appropriate treatment option for this patient?
This question appears in Med-Challenger OBGYN Exam Review with CME
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