A 4 year old female presented to the ER with increased WOB, moderate substernal/subcostal retractions, and rhinorrhea for 2 days. She hasn’t had much of an appetite for the past 24 hours, and has a dry nonproductive cough. Upon physical examination the physician notes anterior/posterior wheezing bilaterally, tachypnea (RR 40), and an SpO2 of 92%, and axillary temperature 99.2 °F. Patient reports dyspnea and is holding her chest. She is unable to talk in full sentences.
Past Medical & Surgical History
- Eczema
- Full term (40 weeks)
- No pertinent surgical history
- Environmental allergies
Pertinent Social History
- Lives with mother and father
- Attends preschool
- Favorite activity is swimming
Imaging and Lab Results
- Chest x-ray: interpretation shows bronchial thickening, hyperinflation and focal atelectasis
- FARVPP: negative swab test
- Sputum culture: came back negative for bacterial infection
Pertinent Family History
- Father and mother smokers for 10+ years, inside and outside of home
- Mother has environmental allergies, takes daily anti-histamine
- Paternal grandfather passed of lung cancer
- No family history of maternal grandparents