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Pediatric cases

The puffer is not working

A 6-year-old with known asthma has been wheezy for two days; today her blue inhaler lasts an hour. Her father has given ten puffs in the car.

Age6 yearsWeight21.0 kg

Pediatrics

6 years old· school age21.0 kggirl, Pediatric emergency, room 7Fictitious educational patient
Caregiver
Father: 'She had a cold on Monday and started wheezing Tuesday. The blue puffer helped for a few hours, now it is only an hour. She had ten puffs through the spacer in the car. She was in hospital with this last winter.'
Immunizations
Up to date, including influenza this season.
Asthma, on an inhaled corticosteroid 'when she remembers'Eczema

Day 3 · 18:15

Grading the attack

She is sitting forward, speaking in short phrases, with intercostal and suprasternal retractions. Widespread expiratory wheeze with reduced air entry at both bases. She wants her dad.

Vitals

HR138high for ageBP102/64RR36high for ageSpO290%T37.4

Read against the school age band (6 to 11 years): HR 75 to 118 awake, RR 18 to 25, hypotension below 82 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

Grade the exacerbation for a 6-year-old.

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