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David was a 5 month old boy who was brought by his mother to the emergency room at childrens hospital at 8:00 am after 12 hours of fever with increasing wheezing and coughing. on admission he was found to be in acute respiratory distress, with a temperature 0f 40.5 C (105F). He was also somewhat underweight for his age. david's kmother reported that he had experienced several episodes of fever, congestion, and noisy breathing over the last month, which has improved with ampicillin until the day of admission. david was the product of a normal term pregancy, labor, and delivery. His mother described him as a sickly child. She was concerned about his feeding behavior, as he would commit frequently, particularly during th efirst hour after feeding. She also commented that during these times his skin became clammy and tasted salted. PHYSICAL EXAM: on physical examination david was found to be a pale, somewhat thin, extremely weak, lethargic child who was slightly cyanotic. His respiratory rate was 80 (normal: 40), and his heart reate was 220 (normal: 90-100bpm). He was clammy and was in extreme respiratory distress. His liver was palpable to 10 cm below the right costal margin, and
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