A father brings his 4 year old son into the emergency department. Adam is noticeably distressed and has been having difficulty breathing for the past 2 hours.

Adam is noticeably distressed and has been having difficulty breathing for the last 2 hours. Adam has a history of asthma but his father states that other mild episodes cleared on their own without medication. This time, Adam’s father gave 8 puffs from the “red puffer” with no symptom relief. He shows you the corticosteroid puffer. You inquire about whether Adam has a short-acting beta-agonist “blue rescue puffer,” but the father says Adam has never been prescribed one.

What is the first step in this situation?