MRCP2-4318

MRCP2-4318

A 25-year-old male with asthma presents to the emergency department with acute breathlessness and wheeze following a recent cold. He has received high flow oxygen, regular nebulised bronchodilators and 200 milligrams of intravenous hydrocortisone.
Upon examination, he appears pale and clammy, and is unable to record a peak flow reading. His pulse is 140 per minute, temperature is 37.3°C, and his oxygen saturations are at 86% on 15 L of oxygen. Upon auscultation of his chest, poor breath sounds are heard bilaterally with a faint polyphonic wheeze.
His arterial blood gas on 15L of oxygen reveals:
pH 7.30 (7.36-7.44)
PO2 8.0 kPa (11.3-12.6)
pCO2 7.8 kPa (4.7-6.0)
HCO3 16 mmol/L (20-28)
What is the most appropriate course of action for this patient?