Soru

A $67$-year-old woman with a severe history of emphysema is brought to the emergency department reporting a three-day history of increasing cough, purulent sputum, and breathlessness. Upon arrival, initial therapies including supplemental oxygen via nasal cannula, nebulized short-acting bronchodilators, and intravenous glucocorticoids are administered. Reevaluation ninety minutes later reveals that the patient is markedly fatigued and utilizing accessory muscles of respiration. She remains fully conscious and cooperative but struggles to speak in full sentences. Vital signs show a respiratory rate of $28$/min and an oxygen saturation of $89\%$ on $4$ L/min of oxygen. Arrange the following clinical interventions in the most appropriate chronological sequence for escalating the management of this patient's respiratory deterioration.