ABSTRACT
A 5-year-old, previously healthy Caucasian boy presents to the emergency department with a 7-day history of worsening anorexia, cough, fever, and respiratory distress. He was seen 5 days previously in a walk-in clinic and diagnosed with a viral syndrome. On examination, the patient's vital signs are temperature of 39°C, respiratory rate of 30 breaths per minute, heart rate of 120 beats per minute, and blood pressure of 100/45 mm Hg. He has intercostal retractions with oxygen saturation of 90% on room air, improving to 95% with high flow nasal cannula. Physical exam demonstrates a patient in severe respiratory distress with absent breath sounds in the left chest and moderate abdominal distention without tenderness.
