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Paediatric SOB Scenario (Responder)

Paediatric SOB Scenario (Responder)

You are covering an event at a local music venue when a steward calls you to assist a 9-year-old child with worsening difficulty in breathing. You meet the patient in a quiet side room. They are in the tripod position and unable to lie down. The child looks slightly pale but shows no cyanosis. Their parent is present and confirms they have a diagnosis of asthma.

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Question 1 of 15

1. Question

What assessment tool can be used to gain a quick initial impression of this patient?

Paediatric Assessment Triangle
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DR ABC
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TWELVE FLAPS
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Paediatric Quick Assess Tool
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Question 2 of 15

2. Question

You gain your first impression and feel the patient may be quite unwell. You request back up and quickly record their observations: HR 134, RR 36, BP 105/67, SpO₂ 93%, Temp 36.9, BM 5.4. The child is unable to complete sentences, appears panicked, and has no other medical history. On inspection, there is no visible recession, but a wheeze is audible.

What is their POPS score?

6–7
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4-5
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3–4
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8–9
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Question 3 of 15

3. Question

You calculate their POPS score at 6–7 (depending on your level of concern). POPS is scored between 0–16, and a score of 6–7 usually means the patient can be discharged safely as they are considered low risk, True or False?

False
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True
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Question 4 of 15

4. Question

Based on their signs, symptoms, and observations, what level of asthma exacerbation is this patient experiencing?

Acute severe asthma
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Life-threatening asthma
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Moderate asthma exacerbation
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Mild asthma exacerbation
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Question 5 of 15

5. Question

Why is the patient’s use of accessory muscles and tripod positioning clinically significant?

It indicates increased work of breathing and respiratory distress, as the patient is compensating by maximising lung expansion
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It indicates hypoxaemia
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It usually indicates an inability to cough mucus from the lungs, so the patient finds this position more comfortable
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It indicates airway obstruction from choking or upper airway restriction
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Question 6 of 15

6. Question

The patient has a spacer, but you believe it is bulky and not very useful. If the patient continues to use their inhaler, that should be sufficient.

False – a spacer increases delivery of salbutamol, especially at higher respiratory rates
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True – the patient should continue using their inhaler as they normally would
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Question 7 of 15

7. Question

According to JRCALC, how many puffs of salbutamol are appropriate in an acute asthma episode?

10
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5
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1
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As many as needed
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Question 8 of 15

8. Question

What side effects can occur with continued salbutamol use?

Tachycardia
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Tremors
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Headache
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Muscle cramps
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Vomiting
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Clamminess
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Question 9 of 15

9. Question

Should you administer high-flow oxygen to this patient in addition to supporting salbutamol inhalations?

Yes
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No
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Question 10 of 15

10. Question

If the patient does not improve after salbutamol administration, what should be your next steps while waiting for the ambulance?

Continue oxygen therapy
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Continue salbutamol administration until side effects become significant
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Update ambulance control on severity of the exacerbation
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Keep the patient as calm as possible
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Get the patient to lie flat
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Question 11 of 15

11. Question

According to JRCALC, if the patient’s heart rate exceeds 140 following repeated doses of salbutamol, this is not usually clinically significant and should not prevent further doses being given?

True
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False
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Question 12 of 15

12. Question

What red-flag features would suggest the patient is deteriorating into life-threatening asthma?

Cyanosis
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Altered conscious level
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Silent chest
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SpO₂ <92%
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Hypotension
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Question 13 of 15

13. Question

What other conditions could present similarly to an asthma exacerbation in a child of this age?

Anaphylaxis
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Gastroenteritis
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Croup
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COPD
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Question 14 of 15

14. Question

What features would help you rule out anaphylaxis in this scenario?

Lack of urticaria
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Lack of angioedema
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Prescribed asthma medication
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Question 15 of 15

15. Question

The ambulance crew arrives shortly after your update to control. You give a rapid handover using the ASHICE mnemonic so they can commence treatment quickly. What additional medications could they administer to the child, particularly if they are deteriorating?

Nebulised Salbutamol
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Ipratropium Bromide
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Hydrocortisone
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IV Magnesium Sulfate
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IM Adrenaline
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