Your patient is a 4-year-old male with a history of asthma. He ran out of his inhaled bronchodilator while visiting his grandparent's farm. On your arrival, you learn that the patient has been having increasing respiratory distress for 20 minutes. The patient has pale, cool, moist skin with cyanosis of his nail beds. He is sitting on the edge of a kitchen chair, leaning forward to breathe. He has a respiratory rate of 50 with the use of accessory muscles and a heart rate of 130. He is anxious and unable to speak more than one or two words at a time. Auscultation of the chest reveals scattered wheezing. As you prepare to treat the patient, he becomes drowsy and his respiratory rate decreases to 12. You can no longer auscultate his wheezes. Which of the following best explains the significance of the change in your patient's status?
A) The absence of wheezing indicates that bronchospasm has resolved spontaneously and the child now only needs supplemental oxygen.
B) Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure.
C) The child has realized that you are going to treat him and is more relaxed than he was initially and has stopped hyperventilating.
D) This makes no sense in an asthma patient, and it is likely that the child ingested or was exposed to a toxic substance, which explains the decreased level of consciousness.
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