A 4 year old male with history of asthma, eczema, and multiple food allergies presents to the Emergency Dept with a cough, congestion, and difficulty in breathing. He has had 5 – 6 episodes of watery, nonbloody, light green emesis. His appetite and activity has been decreased today. He has had no fever, rash, pain, diarrhea, or constipation. The mother says the patient was fine the day prior.
HR 120 BP 96/47 RR 32 T 36.8 C Sat 96% on RA
General Mild to Moderate Respiratory distress with tachypnea
Respiratory Expiratory wheeze bilaterally
Cardiac Mild tachycardia, Regular rate and Rhythm, no murmur
The remainder of the Physical exam, including neurologic exam was normal. The patient was then treated with 3 inhaled albuterol + ipratropium nebs and oral prednisolone in the Emergency Dept and chest and abdominal x-rays were ordered because his respiratory status didn’t change significantly.