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A 7-month-old girl presented to the emergency department with a 12-hour history of difficult breathing. The girl was alert but with a severe tachy-dyspnoea, chest retractions and nodding. Vital signs showed: respiratory rate 70/min, pulse rate 150/min and oxygen saturation 92% on room air. At chest auscultation, mild bilateral basal crackles were noted. Repeated albuterol inhalations, systemic steroid and oxygen administration through high flow nasal cannula were administered, but respiratory distress worsened in the next 2 hours. Capillary blood gas analysis showed: pH 7.37 pCO2 27 mm Hg, HCO3 17 mm Hg. A chest radiograph was performed (figure 1).
Which is the most likely diagnosis in this patient?
Acute respiratory distress syndrome
Acute heart failure secondary to dilated cardiomyopathy
Which test may help to …
Contributors SP, AGS and GC wrote the paper. LC, MB and DC supervised the work. EB supervised the work and approved the final revision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.