Girl with respiratory failure and shock.

A 2-year-old girl with Sotos syndrome presented to the emergency department with dyspnea and seizures. Tachypnea and seesaw respi-ration became evident when convulsions were controlled. On beta-agonist inhalation, expiratory wheezing, and prolonged expiration werenoted.Point-of-care(POC)ultrasoundshowedbilaterallungslid-ing. After endotracheal intubation with neuromuscular blockage, high pressure was required to inflate her chest. The oxygen saturation was 80%–90% on bag-mask ventilation with 100% oxygen; bilateral breath sounds were weak, especially on the right. She was diagnosed with bilateral tension pneumothorax based on the absence of bilateral lung sliding on POC ultrasound, bilateral pneumothorax on chest x-ray (Figure1),heartrateof200beats/min,bloodpressureof92/60mmHg