Respiratory failure (pediatrics) Quiz: Ace Your Exams

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A 13-month-old girl presents to the emergency department in respiratory distress. The parents report that she was eating a carrot when she started coughing and then developed difficulty breathing. Parents report no fever or vomiting. Past medical and surgical histories are non-contributory. Temperature is 37 °C (98.6 °F), pulse is 140/min, respirations are 65/min, blood pressure is 90/50 mm Hg, and oxygen saturation is 70% on room air. On exam, severe work of breathing is noted with intercostal retractions and tracheal tugging. On pulmonary exam, wheezing and decreased air entry is heard over the right lower lung. Heart sounds are normal. The exam is otherwise unremarkable. Blood gas is shown below. Which of the following is the most appropriate next step in management?  
 
 Laboratory value     Results    
 pH     7.29    
 PaO2     58 mmHg    
 PaCO2     60 mmHg    
 Serum bicarbonate      24 mEq/L    

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