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Current Situation
A 5-year-old girl is complaining of difficulty breathing. According to her paternal grandmother, with whom she lives, this difficulty had started the day before, when her respirations had suddenly become "noisy." In addition, the child had started drooling, and the grandmother believed the child's head to be warm and her complexion to be pale. She gave the child acetaminophen. The child is complaining of a headache.
Past Medical History
The child has a history of reactive airway disease, but no recent exacerbations. In addition, there is a history of systemic lupus erythematosus and common variable immunodeficiency, diagnosed at the age of 3 years and secondary to alopecia. Medications she has taken include albuterol, two puffs every 6 hours; prednisone, 2 mL per day; and cyclophosphamide, half a tablet per day.
Physical Examination
The patient is anxious, and demonstrates audible stridor upon examination of the lungs. She is sitting in a forward position, and is in severe respiratory distress.
Vital Signs
Temperature, 104.9°F
Pulse, 170 beats per minute
Blood pressure, 120/59 mm Hg
Respiratory rate, 44 breaths/min
Pulse oximetry, 97% on room air
Questions
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