Code Status case · Beginner · Premium
Shortness of breath in a 31-year-old woman
“I can't catch my breath.”
“Known asthma, worsening for three days. She's used her rescue inhaler four times since midnight with little relief. She's moving air, but not well, and can only get out a few words at a time.”
Your challenge
Nadia has asthma, and she knows what an attack feels like. This one has built for three days, her rescue inhaler has barely helped since midnight, and she can only get out a few words at a time. A bad attack is the obvious answer, but a lung infection, a collapsed lung or a clot in the lungs can also cause shortness of breath. You have to judge how sick she really is, treat her in the right order, and decide whether she is well enough to go home.
After the case, Attending’s Notes explains the decisions that mattered, backed by 10 sources.
Ready to make the call?
Two cases are free. This one is part of Premium.
Spoiler: the diagnosis and what this case teaches
Diagnosis
Acute Asthma Exacerbation
Lesson 1
Speech and Airflow Show Asthma Severity
A reassuring number cannot override obvious respiratory distress.
- Broaden workup for focal findings or poor response
- Short phrases & low airflow signal severe asthma
- Normal oxygen does not exclude severe distress
- Less wheezing can mean too little airflow to produce sound
Lesson 2
Open the Airways, Treat the Inflammation
Bronchodilators work within minutes. Give steroids early because they take hours.
- Give albuterol promptly and repeat according to response
- Add ipratropium early in moderate or severe attacks
- Start prednisone early, usually 40–50 mg daily
- For hypoxemia, target oxygen saturation of 92–95%
Lesson 3
Escalate Persistent Severe Asthma
Deterioration needs immediate action, even before the first hour is complete.
- Escalate if labored breathing and poor airflow persist
- Consider IV magnesium for persistent severe asthma
- Use noninvasive ventilation with intubation backup
- Use epinephrine for anaphylaxis, not asthma
Lesson 4
Exhaustion or Drowsiness Signals Respiratory Failure
Prepare airway support promptly when ventilation is failing.
- Silent chest with distress needs urgent escalation
- Fatigue and drowsiness warn of respiratory failure
- Normal or rising CO₂ warns of failing ventilation
- Discharge only after clear, sustained improvement
- After intubation, allow full exhalation
In the app, every line above opens into the detail behind it: doses, pitfalls and the evidence, with 10 sources linked to the originals.
Nadia is a fictional patient. Code Status is for training only and is not intended for real-world patient care, diagnosis, treatment, or clinical decision-making.