<prompt> A 4-year-old girl asthmatic child is brought to casualty. She is not speaking and has fast shallow breathing with pulsus paradoxsus. ABG shows respiratory acidosis. What is the next best step in management of this patient?Urgent endotracheal intubationHyperbaric oxygen therapyMDI with salbutamol and coicosteroidsTerbutaline subcutaneous with aminophylline drip  <response>: 1. CO2 - Respiratory acidosis - pulsus paradoxus 2. Patients not speaking - Imminent respiratory arrest Do urgent Endotracheal intubation Other option Hyper baric oxygen therapy - CO poisoning, HAPEHigh altitude pulmonary edema MDI with salbutamol - patient cannot inhale Aminophylline - may cause PSVT 