Severe Respiratory Distress

A seven-year-old with a history of asthma presents to the emergency department in severe respiratory distress.

Initial vitals:

R: 40, O₂: 85%, P: 160, BP: 90/60, T: 37.6

On exam, The patient is sitting upright, airway is patent but patient is tachypneic, with intercostal retractions and tracheal tugging. You hear wheezing in all lung fields. No stridor.

While you are administering medications and preparing for intubation, the patient becomes unresponsive.

The monitor demonstrates the following

Despite being unresponsive, the patient has a pulse and is intubated for definitive airway management.

Subsequent to intubation, the blood pressure is markedly decreased and on reevaluation, the patient has become pulseless, although telemetry monitor remains unchanged.

You initiate CPR for this PEA arrest.