A 55-year-old asthmatic patient comes to the ED with an exacerbation. One hour after administration of supplemental oxygen and two nebulizations of salbutamol the patient does not improve. On examination, he breathes at 42 rpm with supraclavicular pull v with scattered inspiratory and expiratory wheezing. Peak flow has decreased from 310 to 220 L/min. A blood gas drawn with 28% oxygen shows a p02 of 54 mmHg and a pC02 of 35 mm Hg. Which of the following do you think is LEAST indicated?
In a severe asthma crisis all options are indicated or may be indicated before more aggressive options. In the case of a bad evolution with acidosis etc., the patient would be tributary to invasive medication.
Increase oxygen flow.
Administer 80 mg of methylprednisolone iv.
Nebulize ipratropium bromide together with salbutamol every 20 minutes.
Administer intravenous magnesium.
 Start noninvasive mechanical ventilation.
In the case of a bad evolution with acidosis etc., the patient would be tributary to invasive medication.