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Next steps in the ambulance

Breathing Difficulties
1
So we’ll just reassess him quick and do some more obs. He's not responding to any of this neb. So we'll do this quickly and then we'll think about leaving, alright?
 Alright. So far we got a second set of obs. We are tachycardic at about 140. Yes. Resp rate is still 40. Yes. Oxygen levels are now 87%. 
Ok, they’re not getting any better are they?
 Not getting better. No. No response on the neb at all.
 Still A on AVPU. Yes? Yes.
21
Temperature’s 36.7</v> Yes.
 And the BM is 5.3 Cool. We're about… from here.
 5 minutes from the Children's from here?
 Yes, about 5 minutes. We’ll get going?
 Yes, we’ll get going and I'll give the hospital a quick ring, alright? Mum, everything's going to be fine ok? Ok
 We’re going to keep on giving him these nebulisers, ok, and hopefully he'll get better. I'm going to give the hospital a ring so there’s a team of doctors waiting for us ok?
Yes.

47
Hi there who's that? It's Cameron with the paramedics from the ambulance service with a medical alert please. Seven year old male. Query severe asthma attack. Yes. Set of obs for you, he’s got a heart rate of 140. Resp rate of 40. Saturations at the moment 87% on nebuliser, he is A on AVPU scale. 36, 7, 10. 5.3 BM.
63
Treatment so far: he’s on his second nebuliser 5 mg salbutamol. Yes - and we’ll be with you in 5 minutes time. That’s great. Cheers, bye bye.
By now we can see that Fraser is very unwell. He has signs of low saturations 87%, tracheal tug, respiratory rate of 40 and a HR 140.
If you look back at the previous severity assessment slide then you will see that this is acute severe asthma.
Concerning features will include that the child has low saturations and appear to be unresponsive to the salbutamol nebulisers.
Just because it looks like a duck and quacks, doesn’t make it a duck! This is almost certainly severe asthma but there are other causes for severe respiratory distress associated with wheeze. Could this be anaphylaxis for example? If you think it is, what are you going to do?
Let us know what you think in the discussion below.
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Emergency and Urgent Care for Children: a Survival Guide

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