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Just wondering how people on the list would manage the airway/breathing of
this child:

18 month old Hispanic male brought in from triage with fever, vomitting and
cough for three days. Patient looks tired but alert, breathing 80
breaths/min, mild retractions, temp 102.8 F, HR 180, BP 98/68. O2 sats 79% on
RA. Lungs are clear on auscultation, cardiac exam normal, no meningeal signs
and except for a whopping otitis on one side he has a normal exam. Mother
gives a vague hx of wheezing but no other past Medical history. Seen in the
ED 36 hours prior with Viral Syndrome and dehydration, given IV hydration for
4 hours and sent home. WBC on prior visit 10.2, lytes not remarkable and O2
Sats 98% RA.

While the nurses set up oxygen, I rushed a RA ABG : 7.40/PCO2
=39/PAO2=46/HCO3=20. Accucheck 76, stat portable CXR shows early RLL
infiltrate. Patient now on 40% O2 via mask, IV hydration and Antibiotics in,
20 mins into arrival, still very tachypneic, tired but alert. O2 sats 96% on
O2.

Question : Would you intubate immediately or would you wait?

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