You are treating a short of breath 9-year-old male with a history of asthma. on scene he presents in severe respiratory distress with noted intercostal retraction, lethargy, and expiratory wheezing. his pulse is 136, respirations 32, and spo2 95%. you have assisted him with his albuterol mdi and are transporting emergently to the hospital. as you reassess the patient, what finding is most concerning?

The answer to this question would be: Heart rate 88

Respiratory distress in asthma patient can be dangerous. It won't only affect the respiratory system but also cardiovascular system. In asthma, the expiration phase is longer and harder because of the obstruction. This will cause lower amount of oxygen gain and lower amount of carbon dioxide dumped. The right ventricle also needs extra force since the lungs pressure is increased. The heart rate should be increased in this case to compensate the lower oxygen level. 

Heart rate 88 is normal, not increased. This is a sign that the heart is already tired and might go arrest.