A 15 month old boy is brought to the emergency department by his parents because he is having noisy breathing. He is usually healthy, but yesterday he began having a runny nose, congestion, watery eyes, a mild cough and a slight fever. His appetite is d ecreased. His 6 year old brother has a cold. The patient was put to sleep at 10 pm and he awoke at 1 am with a bark like a seal and noisy breathing. The parents tried Vicks 44 vapor rub without improvement.

He was full term, no medical problems, no family history of asthma.

Vicks 44, no allergies.

Appearance:	VS Temp 38.2C, RR 42, HR 165, Sat not registering. He is in moderate respiratory distress and becomes agitated with further attempts at O2 Sat monitoring.
HEENT:	TM's clear, neck supple, + rhinorrhea and congestion, throat clear, no lymph adenopathy.
Lungs:	Stridorous, but no wheeze, with some air movement.
Heart:	Tachy no murmurs
Abdomen:	benign
Extremities:	good turgor, no rashes.
Neuro:	Awake and aggitated