Worrying sign in an acutely ill asthmatic child? (400/1700)

A child suffering from asthma presents with Temp 39C, drooling saliva on to the mother’s lap,
and taking oxygen by mask. What sign will indicate that he is deteriorating?
a. Intercostal recession
b. Diffuse wheeze
c. Drowsiness































answer: C

Drowsiness indicates hypoxic ischemic brain manifestations and this can develop into brain injury and it is a more serious deterioration compared to:

a mild asthma exacerbation may present with subcostal retractions, a moderate exacerbation may present with intercostal or suprasternal retractions, and a severe exacerbation may present with sternocleidomastoid retractions.