In the ED, their vitals/exam are significant for tachycardia, increased respiratory effort and rate, inspiratory and expiratory wheezes heard throughout, and diminished sounds at the apices bilaterally. Differential includes asthma exacerbation, PNA, viral URI. Lower suspicion for PE as patient without pleuritic CP or LE signs of DVT including no edema/unilateral swelling/calf pain. Lower suspicion for primary cardiac etiology given EKG and lack of hypervolemia on exam. No history to suggest foreign body aspiration.
– Labs/Tests: VBG, CBC, CMP, Flu swab, COVID swab. Consider blood cultures if concerned for pneumonia.
– Imaging: CXR***
– Treatments: Escalating respiratory support as indicated (NC -> NRB -> HFNC -> BiPAP -> Intubation), Duonebs PRN, Methylpred 125mg, Magnesium 2-4g IV +/- IVF. Consider terbutaline 0.25mg SQ and epinephrine 0.3mg IM if refractory symptoms.
– Consults: None
– Dispo: Pending further testing and symptomatic improvement