He was alert and anxious, with obvious tachypnea and retractions. Suprasternal, intercostal, and subcostal retractions present. Breath sounds are faint throughout the chest, without auscultatory rales, wheezes, or stridor heard. Heart sounds are distant, and no murmur is heard. Pulses are strong and regular.
Capillary refill is brisk.
There are no rashes. Abdominal, neurologic, and musculoskeletal exams are unremarkable. A CBC with differential, blood culture, electrolytes, glucose, UA and CXR are obtained. On oxygen by mask, his pO2 increased to 150. A chest radiograph is obtained.