Resuscitation is the first priority. Maximum inspired oxygen should be given by facemask: this is best achieved using a reservoir bag at a flow rate of 15 l/min, which can generate an FiO2 of about 85%. Nebulised salbutamol (5-10 mg) driven by oxygen should be given, and many would add ipatropium bromide (Atrovent, 500 microg) to the nebuliser chamber at the same time as the salbutamol. If the woman does not improve, then call for assistance from ICU sooner rather than later.
Although it is always important to consider pneumothorax in any breathless patient, there is no evidence at all to suggest that this woman has bilateral pneumothoraces and she would not be well served by chest decompression.
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