Case 1:

A 26-year-old white female was brought to the Emergency Room by her boyfriend because of shortness of breath and wheezing. She claims to have "asthma" which has been worse for the past two months. Recently, she complains of more frequent and severe attacks in addition to a persistent cough which has been especially troublesome at night. She has started to intermittently produce increasing amounts of thick yellow sputum and complains of frontal headaches, especially in the morning, for the past two weeks. She complains of chest tightness but denies fever. She has been using Primatene Mist every 1 to 2 hours for the past 24 hours with decreasing efficacy.

The ER physician notes that the patient is in moderately severe respiratory distress and is unable to lay flat. Vitals: BP 150/90 (pulsus paradox = 20), HR = 120, RR = 24, T = 37.0. Accessory muscle use was noted as well as diffuse inspiratory and expiratory wheezing. The rest of the exam was normal.

A pulse oximeter revealed an oxygen saturation of 91% on room air. Peak Flow was 100 liters/min.

Before obtaining more history, the ER physician orders the following: