A 5 year old male child presents to the Emergency Department with respiratory distress. The child is on a monitor as displayed. 

HPI:

The child presents with a sudden onset of shortness of breath, cough and rash. The child is allergic to peanuts and nuts and has had previous episodes of respiratory distress. There are known sick contacts.

PMx:

The child is unimmunized. There is a family history of food allergies. The child is following a normal growth curve. There is a history of mild eczema.

O/E:

The child is in marked respiratory distress with audible expiratory wheeze. The child has difficulty speaking.