A 24-year-old woman with known asthma presents to the emergency department unable to complete a sentence. Respiratory rate 32/min, heart rate 128/min, pulsus paradoxus present, SpO2 90% on room air. Which single finding would place her in the life-threatening category rather than acute severe asthma?
- A Pulsus paradoxus greater than 10 mmHg
- B Silent chest ✓
- C Peak expiratory flow less than 50% of predicted
- D Respiratory rate greater than 25/min
Correct answer: B. Silent chest
Explanation
B silent chest indicates such severe airflow limitation that insufficient air moves to generate wheeze, marking imminent respiratory arrest and the life-threatening category. PEF below 33% predicted, cyanosis, feeble effort, exhaustion, bradycardia or arrhythmia are other life-threatening markers. The remaining options define acute severe asthma: PEF 33 to 50%, RR above 25/min, pulse above 110/min, and inability to complete sentences.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.