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During a severe asthma attack, the child sits upright and is very agitated, speaking in words only. The shoulders are hunched over, and every chest, neck, and stomach muscle is enlisted in the struggle to breathe. Very loud wheezing now extends throughout the breathing cycle, both inhalation and exhalation, with a rapid respiratory rate. Bronchodilators, steroids, intravenous fluids, and oxygen should have been given to the child in the emergency room or hospital by now. The peak flow will be less than 50 percent of the child's best. Blood gases -- oxygen and carbon dioxide -- will be abnormal even if oxygen is being administered.
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