If they called 911 before even using their inhaler and were in full panic mode when I got there 5 minutes later, despite no objective evidence of a severe attack, then I'd probably agree that anxiety is a component. Anxiety is common in asthmatics, and it can sometimes cloud the picture a little. Turns out it's scary to feel like you are slowly suffocating to death.
But if someone calls after an attack has been going on for a good part of a day and multiple inhaler treatments have failed, then anxiety would be low on my list of differentials.
I wouldn't be worried about the vitals that Angel listed, either. But I would not be dismissive of a day-long asthma attack that was refractory to nebs and slowly worsening. That is actually the classic description of an asthma attack that progresses to life-threatening.
The whole point is not to wait until their RR is 50 and their HR is 160 and their lips are blue.
Trust has nothing to do with it.
It's pretty rare that I call something "always right or always wrong", but this is one of them. Status asthmaticus is an ALS call. Turfing it to BLS when ALS is available is lazy and inappropriate, period.
And "ALS is always the answer" is a straw man. I never said anything even remotely like that. Clearly ALS is more appropriate than BLS in some cases, and this is one of those.
So she's compensating because she's young and (presumably) healthy, and because the attack has not yet progressed to the point that her compensatory mechanisms fail. That's a good thing.
That's not an excuse to be complacent thought, because it doesn't mean she isn't really sick. What it means is you have the opportunity to manage aggressively and prevent progression, rather than waiting until she is in extremis when your therapies are less likely to work.
Thinking something is very likely to happen and being concerned about the possibility of it happening are not the same. It's my job to think about - and be concerned about - what might happen.
Status asthmaticus has an overall mortality rate ranging from 4%-9%, and with certain co-morbidities the chance of death is much higher. 85% of asthma-related deaths follow a gradually worsening attack that lasted longer than 12 hours, rather than an abrupt, severe attack.
Asthma refractory to inhaled b-agonists and combined with a patient description of worsening dyspnea over a period of hours should get your attention like few other things.
