The team arrive to find a challenge in more ways than one...

In this short clip, we sees the paramedics arriving at the scene where there is a poorly looking Marley. Unfazed by the access issues, the paramedics perform an initial assessment which shows that Marley has a patent airway, he is grunting with saturations of 89% in air, he has reduced air entry on one side of the chest and wheeze on the other, and he is tachycardic. He is also pyrexial.

• We have used the term ‘grunting’. What do we mean by grunting and what is happening when a child grunts?
• From what you have seen in this short clip what do you think is going on here and what are your immediate priorities?
• What practical problems do you anticipate in his management and what suggestions do you have to how you would overcome them?