This case is written by Dr. Eve Purdy, an applied anthropologist and Emergency Medicine physician at Queen’s University in Kingston, Ontario. She has completed a fellowship in Translational Simulation and Team Performance at Gold Coast University Hospital in Australia.
WHY IT MATTERS
Acute asthma exacerbations in children are extremely common. Most asthmatic exacerbations respond quickly to basic treatment with beta-agonists, anticholinergics, and steroids. This case highlights the management of those patients who need treatment that goes beyond the basics.
Critically ill pediatric patients are anxiety provoking for many emergency medicine providers and simulation can help prepare individual providers, enhance team dynamics and test clinical systems. This cases pushes participants to the furthest reach of asthma treatment for a young, vulnerable patient.
A 5-year-old boy arrives via EMS with increased work of breathing. He has known asthma and has been using his puffer more over the past 3 days. He has been given one dose of nebulized salbutamol on route with paramedics. He is audibly wheezy and appears unwell.
A 5-year-old male with a history of asthma presents with a three-days of cough, wheeze and worsening shortness of breath. The team must recognize severe asthma and initiate usual asthma treatment, but the child does not respond to these basic treatments and continues to worsen. The team should escalate management – epinephrine, magnesium, ketamine. The patient continues to tire and requires intubation. Post-intubation, the team must optimize ventilator settings/paralyze/bear hug. If not treated aggressively, the patient will become hypoxic and bradycardic, potentially leading to arrest.