EM Forum Case #143 "Is it Asthma?"
by Charlene Babcock Irvin, MD, FACEP
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I’m called to resuscitation for a ‘Code I Pediatric Medical’ Patient. Walking into the room I asked the nurse walking out, “What’s up?”
“Severe asthma attack,” she responded.
Within 2 more steps, I see a 6 y/o male, on the stretcher, in obvious respiratory distress. Audible Inspiratory Stridor is heard, and as his shirt is removed, substernal retractions of 2 inches are noted. He is moving in and out of the ‘tripod’ position between periods of agitation. His lips are cyanotic, and he has significant air hunger and is in significant distress. His mother at his side is crying and repeating: “Please help my baby!!”
The monitor is showing HR: 170, RR=46, Sat=78% (RA), Blood pressure cuff is applied. The nurse is applying a tourniquet to start an IV, and a 100% oxygen mask is being applied.
Questions:
1. Is this an asthma exacerbation?
2. As the nurse is attempting an IV, what do you order?
3. What are the key questions to help determine the cause of his respiratory distress?
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