Had a 34-year-old with moderate asthma exacerbation in clinic; after two back-to-back albuterol/ipratropium nebs and [redacted] prednisone, SpO2 hovered at 92% on room air with RR 28. I transferred to the ED, but where do you all draw the line — do you initiate magnesium or IM epi in-clinic if you’ve got protocols and monitoring, or is that a hard transfer once response stalls like this?