From the Research
I would recommend adding a chest X-ray and arterial blood gas to the assessment plan, as well as considering bronchodilator therapy and a more structured fluid challenge to manage the patient's hypotension and respiratory symptoms. The patient's presentation with hypoxia, hypotension, fever, and wheezing suggests a lower respiratory tract infection (LRTI), and a chest X-ray would help confirm this diagnosis and rule out other pulmonary pathologies 1. An arterial blood gas would provide valuable information on the patient's oxygenation status and help guide oxygen therapy 1. Given the patient's bilateral wheezing, adding bronchodilator therapy such as nebulized albuterol/salbutamol may help improve respiratory symptoms and oxygen saturation 2. For the persistent hypotension, a more structured fluid challenge (250-500mL crystalloid bolus) with reassessment, rather than waiting for further deterioration, is recommended 3. The use of vasopressors such as norepinephrine and vasopressin may be considered in patients with vasodilatory shock, but their effects on blood flow must be carefully monitored to avoid excessive vasoconstriction 4, 1. Regular antipyretics like acetaminophen/paracetamol should be administered to manage the patient's fever, and more frequent vital sign monitoring (every 1-2 hours) should be implemented to track response to interventions 1. Calculating an early warning score may also be helpful in objectively monitoring for clinical deterioration 1. It is also important to note that the patient's urine output and kidney function should be closely monitored, especially if vasopressors are used, as they may be associated with increased mortality in patients with acute kidney injury 5.