Question

A 7-year-old female weighing 26 kg presents to the emergency department with an asthma exacerbation. Her mother reports she has had an upper respiratory tract infection for the last 2 days and has been using her albuterol inhaler more frequently. Today she has received treatments every 2 to 3 hours but still complains of shortness of breath and has frequent coughing. She reports taking her controller medication, Flovent 44 mcg 2 puffs bid as prescribed. Her mother states that the patient uses her controller medication every day. Your assessment reveals the following: an alert yet anxious 7-year-old, sitting on the edge of the bed leaning forward. She has moderate inter- costal retractions. You ask her to tell you her name and favorite activity at school, but she must stop and take a breath after four words. At this time, vitals are as follows: heart rate of 140 beats per minute, respiratory rate of 42 breaths per minute, SpO2 at 93% on room air, blood pressure of 90/60 mm Hg, temperature of 37.5°C. Upon auscultation, breath sounds are diminished with very faint expiratory wheezes throughout all lung fields.

1. You are called to the room.

   Your reassessment after an hour reveals the following: heart rate of 156 beats per minute, respiratory rate of 36 breaths per minute, SpO2 at 95% on room air. Mild intercostal retractions persist. Breath sounds reveal increased expiratory wheezes throughout all lung fields. The patient status has improved after an additional hour of observation (heart rate of 140 beats per minute, respiratory rate of 28 breaths per minute, SpO2 at 98%, blood pressure of 88/60 mm Hg). Intercostal retractions are no longer present. Breath sounds show improved air entry throughout all lung fields, and few expiratory wheezes persist. The patient is discharged home with follow up with her primary care physician in 2 days.

2. Are there other recommendations that you might make for this patient at this time?

Answer 1

The intercoastal retraction happens when there is partial or complete lower or upper airway blockage.This retraction indicates something is narrowing the airway. Following disease cause the airway intercoastal retraction:

• Pneumonia
• Asthma
• Epiglottitis
• Respiratory distress syndrome, etc

Recommendations:

• we can't prevent this but we can reduce the risk
• keep the places clean where you will be keeping the patient
• Ensure dust-free Environment
• keep foreign object away from the children
• Prevent the sources of viral infection - 1. By avoiding contact with sick people.2. Frequent Hand Washing.
• Avoid smoking near the children
• Listen for any abnormal breathing sound
• Dont insist the person to talk if he/she is not comfortable
• Have a look on childs behavior pattern like difficult to walk etc
• Observe for the body position. Eg, the child may lean forward to breathe
• If these symptoms persist call your health care provider