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A 7-year-old presents to the ED with a severe asthma exacerbation. After three back-to-back albuterol nebulizations and oral dexamethasone, she remains in moderate distress with SpO2 90%. What is the next appropriate pharmacologic step?
Inhaled tiotropium
IV aminophylline
IV ketamine
IV magnesium sulfate 25-50 mg/kg
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IV magnesium sulfate 25-50 mg/kg
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