An 8-year-old girl presents to the emergency room with exacerbation of her asthma. She has been hospitalized five times previously, requiring salbutamol via nebulizer, oral slow-release theophylline preparation, and chest physiotherapy. She presents now with increased shortness of breath and wheezing that has gradually worsened over the past 24 h. On examination, she is pale, distressed, and hardly able to speak. Her vital signs are the following: heart rate: 136 beats per minute (bpm); blood pressure (BP): 140/60; and respiratory rate: 30 breaths per minute with poor air entry to both lung fields and soft, high-pitched wheezes heard all over.
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