At what step should Angela begin therapy? (a 7 y/o African-A…

At what step should Angela begin therapy? (a 7 y/o African-American female is brought into the emergency department complaining of shortness of breath.  While interviewing the patient, the mother informs the RCP her daughter has been awakened approximately two times per week due to her asthma symptoms.  Upon further questioning she mentions the school nurse called yesterday because Angela has been in her office for her quick relief medication everyday in the past week.  Her last FEV1/FVC ratio was 72%.)

A 5 year old with “trouble breathing”.  Initial impression f…

A 5 year old with “trouble breathing”.  Initial impression finds a child lethargic, no abnormal sounds, with pale, mottled skin.  Primary assessment is A: clear, B: RR 36/min, mild retractions, nasal flaring, crackles at the lung bases, SpO2 93%, C: HR 140, weak peripheral pulses, delayed capillary refill, BP 74/54, D: Lethargic, E: Afebrile, no rashes. Which of the following is most accurate?