Final answer:
In a severe asthma attack with low oxygen saturation and no relief from initial medication, applying high-flow oxygen via a non-rebreather mask is the recommended next step, followed by reassessing treatment response for possible additional interventions.
Step-by-step explanation:
A 33-year-old female with acute respiratory distress and a history of asthma, who is conscious but anxious, has already used her albuterol inhaler without relief. Her oxygen saturation at 89% and diffuse wheezing suggests significant bronchoconstriction and impaired gas exchange. Given the acuity of the presentation and that initial bronchodilator therapy was ineffective, immediate escalation of care is warranted. The appropriate next step would be to apply high-flow oxygen via a non-rebreather mask to address the hypoxemia (low blood oxygen level) evident from her oxygen saturation level. Simultaneously, it would be prudent to prepare for possible advanced interventions, including further bronchodilation with nebulized albuterol, administration of systemic corticosteroids, and if warranted based on clinical assessment, consideration for epinephrine to reduce airway inflammation and swelling if anaphylaxis is suspected. Monitoring and reassessing response to treatment are crucial, and if she shows signs of deterioration, additional support such as assisted ventilations or advanced airway management may be required. Always consider the presence of wheezing and the response to initial medication to guide further management decisions