It was a busy day in the emergency department (ED); the waiting room overflowed with a cacophony of wheezing, retching, coughing, and crying. I had diagnosed dozens of cases of bronchiolitis this week as a fellow in the ED, but Alex* was the sickest child I had seen in a while.
Alex was a sweet 4-month-old infant with big dimples and bright brown eyes. Today, however, Alex was in respiratory failure. His mother told me how his retractions had gotten worse at home, and he stopped making wet diapers. She counted his breaths: >80 times per minute. She had called an ambulance, frantically worrying he would stop breathing. He arrived febrile, tachypneic, and hypoxic, and our team in the ED quickly connected him to monitors, started oxygen, and obtained intravenous access. His family was exhausted, tearful, and petrified. I know what to do next; he needs oxygen, positive pressure,...
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