Emma, a 19-year-old college student with a history of asthma since childhood. She uses an albuterol inhaler PRN and takes a daily inhaled corticosteroid.
Emma presents to the emergency department with shortness of breath, wheezing, and chest tightness that started 2 hours ago. Her albuterol inhaler at home did not provide relief.
Emma arrives in the ED. She is sitting upright, leaning forward, speaking in short phrases. Her respiratory rate is 28, SpO2 is 90% on room air, and you hear diffuse wheezing. What is your first priority?
"I can't... breathe... it's getting... worse."