A 3 year old female 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 no known sick contacts.

PMx:

The child's immunizations are delayed. 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 inspiratory and expiratory wheeze. The child has difficulty speaking.