Hannah Rosen is 18-year-old female who presents to the outpatient clinic after a frantic call to the receptionist earlier during the day. Hannah has been coming to the clinic for the past 16 years for treatment and monitoring of her cystic fibrosis. Her parents, who have been supportive, are out of town on an anniversary cruise and Hannah didn’t know who to call. Hannah states she has been having increased sputum production, low grade fever and difficulty catching her breath over the past few days. She took the action plan of ciprofloxacin she has at home. She takes this when her respiratory symptoms worsen. Hannah states she has been compliant with her antibiotics, but her symptoms suddenly got worse overnight. Hannah does not want her parents to know about this and asks that they not be contacted about her hospital visit. On examination, Hannah appears in distress. She is using her intercostal muscles to help her breathe and appears cyanotic and diaphoretic. Her vitals are taken by the clinic nurse while they are waiting for her pediatric respirologist to finish with the previous patient. Hannah’s temperature is 39.1, oxygen saturation is 91 percent, heart rate is 115 and her blood pressure is 100/60. The nurse calls for immediate help and Hannah is taken to the ICU where she is placed on oxygen. Chest x-ray and additional blood work including ABGs are ordered.