Problem:
A 10-year-old child is brought to the emergency department (ED) because of severe shortness of breath and chest tightness that began an hour after the child returned from a friend's house. The parents report that the child has a history of airway disease and always has attacks after visiting this friend, who has a dog. The child used the inhaler several times but continued with severe dyspnea and wheezing. The parents report that there is a history of allergies to eggs, pet dander, grass, pollen, and cigarette smoke. They also reveal that the child's sibling has eczema. On examination, the child is found to be in moderate respiratory distress with nasal flaring and using accessory muscles of respiration. Diffuse wheezes are detected bilaterally with auscultation. Vital signs are temperature 97.2° F (36.2° C), heart rate of 110 beats per minute, respiratory rate of 30 breaths per minute, blood pressure of 102/68, and pulse oximetry reading of 88%.