[Expert Solution]: CC: “Please help, my daughter cannot…

CC: “Please help, my daughter cannot breathe.” HPI: AN is a 12 yo female presents to the ER with labored breathing. She has a known history of asthma for the past 8 years and currently is wheezing and acutely SOB while seated. Patient can only speak 1-2 words at a time and gasps for air periodically. Appears agitated and worried. Using her albuterol inhaler every hour with little relief. Reports PEF at home of 30%. Ran out of steroid inhaler 10 days ago. Started to become SOB 2 days ago, but SOB much worse today. PMH: Asthma FH: Mother; alive age 40; Father; alive age 41 SH: (-) tobacco, illicit drugs, alcohol; lives in an apartment with her parents and sister. Family has a dog. Current Medications: Albuterol inhaler 2 puffs inhaled PO Q4-6H PRN SOB Fluticasone diskus 250mcg 1 inhalation PO Q12H- has not taken in the past 10 days Allergies: Penicillin- hives ROS: (+) coughing, SOB, chest tightness; (-) fever, N/V/D, headache, chest pain PE: Gen:12-year-old female in acute distress VS: BP 122/84 mmHg, HR 126, RR 32, T 37°C, Ht 150 cm, Wt 40 kg HEENT: (+) PERRLA, EOMI, TM’s intact Lungs: (+) wheezing, (+) accessory muscle use SaO2: 87%