Paeds Cases · respiratory-sleep-and-airway
Manage a child with acute severe asthma in the emergency department — OSCE
OSCE management station: assessing and treating a school-age child with acute severe asthma who is not responding to home reliever, delivering the stepwise pathway, recognising deterioration, escalating to intravenous therapy and critical care, and planning safe discharge and prevention.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A 9-year-old boy with known asthma is brought to the emergency department by ambulance. His mother says his wheeze started with a cold two days ago and has worsened all day despite salbutamol every hour at home. On arrival he is sitting forward, speaking in short phrases, with marked recession, a widespread expiratory wheeze, a respiratory rate of 38, a heart rate of 145, and an oxygen saturation of 89% on air. You are the paediatric registrar asked to assess and manage him.
Candidate brief
You have this station to assess a 9-year-old with acute asthma, deliver the initial management, recognise and respond to deterioration, and outline safe disposition. Assess severity from the whole child, treat immediately and in the right order, and reassess after every step. [1] [2]
References4ShowHide
- [1]Leung JS. Paediatrics: how to manage acute asthma exacerbations. Drugs Context, 2021.PMID 34113386
- [2]Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev, 2013.PMID 23966133
- [3]Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev, 2016.PMID 27126744
- [4]Edmonds ML, Milan SJ, Camargo CA Jr, et al. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev, 2012.PMID 23235589