11th May 2024

A 3-year-old boy is brought to the emergency department with severe difficulty breathing and altered consciousness.

A 3-year-old boy is brought to the emergency department with severe difficulty breathing and altered consciousness. He has a history of severe asthma and his parents report he has been increasingly wheezy and coughing over the last 24 hours. On examination, he is drowsy, cyanotic, and unresponsive to verbal stimuli. He has minimal chest wall movement, absent breath sounds, and weak peripheral pulses. The capillary refill time is 4 seconds.

Which is the most appropriate next step in management?