Winded : Part 1

A 6 year old boy presents with wheezing and a nonproductive cough for 2 hours.

He is a refugee, and thus detailed medical records are unavailable. However, his mother mentions that he has experienced recurrent episodes of wheezing from the age of 7 months onwards; for the last 2 years, these have occasionally been accompanied by cyanosis and epistaxis.

He has also been persistently anemic from the age of 3 years, which was attributed to a poor diet.

His surgical and family histories are unremarkable, while his development is age-appropriate, and all immunizations are up to date.

At the emergency department, he was started on oxygen via face mask and back-to-back nebulization with salbutamol and ipratropium bromide. However, his vital parameters have continued to deteriorate.

An urgent chest X-ray reveals reticular and nodular opacification of the perihilar and basal regions with sparing of the apices and costophrenic angles. An ECG is normal.

Select Relevant Investigations
Complete Blood Count


WBC: 12,700/mm3 (5,000-10,500)
N: 68%
L: 23%
Hb: 10.9 g/dL (13.5-16.5)
Hct: 32.1% (41.0-50.0)
MCV: 78.2 fL (80-100)
MCH: 26.5 pg/cell (27-33)
MCHC: 33.8 g/dL (33-36)
Plt: 270,000/mm3 (150,000-400,000)
Portable Echocardiography


The echocardiogram is completely normal.
Arterial Blood Gases


FiO2: 60%
PaO2: 58 mmHg (80-100)
PaCO2: 46 mmHg (35-45)
pH: 7.34 (7.35-7.45)
HCO3: 24 mEq/L (22-26)
CT Pulmonary Angiography


The patient is not stable enough to undergo a CT pulmonary angiogram.

Select Relevant Management
Intubation & Ventilation
IV Ceftriaxone
Blood Transfusion
Chest Physiotherapy