Is it enough?
Twenty two month old Bangladeshi baby B, who had a history of recurrent wheezing since the age of 6 months, presented with acute respiratory distress accompanied by nasal flaring, marked intercostal and subcostal recession, tracheal tug, and accessory muscle use. She also appeared very pale. Unusually, she had not responded to her bronchodilator inhaler and was progressively worsening. The attending doctor found it difficult to take a history as her mother could only speak in Bengali and no interpreter was present. Instead, he was forced to rely mostly on clinical signs.
Although the doctor started rigorous treatment for life threatening asthma, the baby's signs and symptoms showed no noteworthy improvement. A reduction in her Glasgow coma scale score (from being alert on admission to occasional eye opening and being unresponsive to pain) and increasing exhaustion prompted the anaesthetic team to intubate and ventilate baby B.
On cannulation, her blood was