Emergency
philomena - 07-12-11 05:11

A 4-year-old boy with asthma becomes limp during treatment with inhaled albuterol in the emergency department. Ten minutes ago, he received intravenous methylprednisolone for an acute exacerbation, and he was alert and oriented at that time. He received the diagnosis of asthma 2 years ago and has been admitted to the hospital for acute exacerbations eight times since then. Current medications include albuterol and montelukast. He appears pale and gasps and moans as he attempts to breathe. He responds to voice. His temperature is 36°C (96.8°F), pulse is 160/min and thready, respirations are 18/min, and blood pressure is 50/20 mm Hg. The skin is cold to the touch. Pulmonary examination shows poor air movement, especially on
the left. No wheezes are heard. The point of maximal impulse is 2 cm to the left of the midclavicular line in the sixth intercostal space. Which of the following is the most likely underlying cause of this patient's hypotension?