Acute asthma

The 40 years old patient is brought on a stretcher to the Emergency. We can hear from the distance coughing and wheezing, he hardly speaks and while pronouncing a sentence he has to breathe repeatedly. The patient is in a semi-fowler position. We can observe the use of auxiliary respiratory muscles and the jugular retraction. From his medical history we know that he has been treated for more than 20 years for asthma and during last two years he was repeatedly hospitalized for asthma decompensation. What needs to be done as first?
40
years
man
RR
29 /min
HR
106 /min
SpO2
90 %
BP
168/100 (123) mmHg
Examination
Aspection: retraction of the subclavian areas, gray color of the skin; auscultation - whistling, creaking, percussion: hypersonic.
Glycaemia
Gly
7,0  mmol/L
Arterial blood gas
pH
7,32
pCO2
45  torr
pO2
76,5  torr
Complete blood count
HGB
130  g/L
HTC
0,38
LEU
11  x109/L
PLT
320  x109/L
Biochemical analysis
Na
144  mmol/L
K
4  mmol/L
Cl
102  mmol/L
Glycaemia
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Arterial blood gas
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Complete blood count
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Biochemical analysis
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