A 10-Year-Old Male with Acute Severe Asthma
Exacerbation: An i-Human Simulation Case
Study on Emergency Pediatric Respiratory
Management, Triage, Diagnosis, and
Treatment Planning.
i-Human Case Study: Pediatric Acute Asthma
Exacerbation
Case Identification
• Patient Name: Lucas Bennett
, • Age: 10 years old
• Gender: Male
• Setting: Metropolitan General Hospital Emergency Department
• Chief Complaint: "Difficulty breathing and wheezing"
• Triage Time: 14:30
Initial Presentation & Triage
Triage Note: Lucas arrives with mother, leaning forward in chair, speaking in short
phrases. Audible wheeze noted at desk. Symptoms began this morning, worsened over
past 2 hours despite two albuterol inhaler doses at home.
Initial Vital Signs:
• Heart Rate: 132 bpm (tachycardic)
• Respiratory Rate: 38 breaths/min (tachypneic)
• Temperature: 37.2°C (98.9°F) (afebrile)
• Blood Pressure: 108/72 mmHg
• SpO2 on Room Air: 91% (hypoxemic)
• Pain: 4/10 (chest tightness)
Immediate Action: Placed in Room 4, started on supplemental O2 via nasal cannula at
2L/min.
History of Present Illness
Lucas is a known asthmatic diagnosed at age 5. According to mother:
• Onset: Woke with dry cough and mild shortness of breath this morning
• Triggers: Attended birthday party yesterday at friend's house with cat (known cat
allergy). Weather has been chilly/damp.
• Progression: Symptoms worsened at school → teacher called mother at 13:00 →
albuterol MDI given at 13:15 and 13:45 with spacer → minimal improvement
• Severity: Unable to speak in full sentences, too breathless to run/play
• Associated Symptoms: Non-productive cough, chest tightness, fatigue. No
fever/vomiting.
Past Medical History & Medications
, • Diagnoses: Persistent Asthma (moderate severity)
• Allergies: Cats, dust mites, ragweed (environmental). NKDA.
• Current Medications:
o Controller: Fluticasone propionate 110 mcg, 2 puffs BID (last dose this
morning)
o Rescue: Albuterol MDI 90 mcg, 2 puffs every 4-6 hours PRN
• Prior Hospitalization: One asthma admission at age 6, no ICU admissions
• Immunizations: Up to date
Social & Family History
• Social: Lives with mother and younger sister. 4th grade student. Plays soccer
(sometimes uses albuterol pre-game). Non-smoking household.
• Family History: Mother with asthma/allergic rhinitis. Father with eczema.
Physical Examination Findings
General: Anxious, sitting upright, tripod positioning, respiratory distress
Vitals on O2: HR 128, RR 36, SpO2 94% on 2L O2, Temp 37.1°C
HEENT: Mild perioral cyanosis, nasal flaring
Respiratory:
• Inspection: Intercostal and subcostal retractions, prolonged expiratory phase
• Palpation: Symmetrical chest expansion
• Percussion: Hyper-resonant throughout
• Auscultation: Diffuse high-pitched expiratory wheezes, markedly diminished
breath sounds at right base, coarse rhonchi
Cardiovascular: Tachycardic, regular, no murmurs, capillary refill 2 seconds
Abdomen: Soft, non-tender, uses abdominal muscles for expiration
Diagnostic Assessment
Bedside Testing:
• Peak Expiratory Flow: 45% of personal best (250 L/min → 112.5 L/min)
• Venous Blood Gas: pH 7.32, pCO2 48 mmHg, HCO3 24 mEq/L (acute respiratory
acidosis)
Imaging:
, • Portable CXR: Hyperinflated lungs with flattened diaphragms. No
consolidation/pneumothorax.
Labs: CBC with differential pending
Severity Classification & Diagnosis
Primary Diagnosis: Acute Severe Asthma Exacerbation (Status Asthmaticus)
PRAM Score: 8/12 (Severe) initially → 4/12 (Moderate) after treatment
Key Findings Supporting Diagnosis:
• Known asthmatic with failed home rescue treatment
• Physical exam showing respiratory distress with wheezing/diminished breath
sounds
• Objective: SpO2 91% RA, PEF 45%, VBG showing respiratory acidosis
• CXR: Hyperinflation without complications
Emergency Department Management
Phase 1: Initial Stabilization (First Hour)
1. Oxygen Therapy: Upgraded to simple face mask at 10-15 L/min (target SpO2
>94%)
2. Bronchodilators:
o Albuterol 2.5mg + Ipratropium 0.5mg nebulizer STAT
o Albuterol 2.5mg nebulizer every 20 minutes × 3 doses (back-to-back)
3. Systemic Corticosteroids: Prednisolone 60mg PO STAT (2 mg/kg dose)
Phase 2: Response Assessment
After 1st Nebulizer (15:15): Slight improvement, ongoing distress → ordered back-to-
back nebulizers
After 3rd Nebulizer (16:15): Significant improvement:
• Speaks in full sentences
• Wheezing decreased to moderate intensity
• Retractions decreased
• PEF improved to 65% personal best
Exacerbation: An i-Human Simulation Case
Study on Emergency Pediatric Respiratory
Management, Triage, Diagnosis, and
Treatment Planning.
i-Human Case Study: Pediatric Acute Asthma
Exacerbation
Case Identification
• Patient Name: Lucas Bennett
, • Age: 10 years old
• Gender: Male
• Setting: Metropolitan General Hospital Emergency Department
• Chief Complaint: "Difficulty breathing and wheezing"
• Triage Time: 14:30
Initial Presentation & Triage
Triage Note: Lucas arrives with mother, leaning forward in chair, speaking in short
phrases. Audible wheeze noted at desk. Symptoms began this morning, worsened over
past 2 hours despite two albuterol inhaler doses at home.
Initial Vital Signs:
• Heart Rate: 132 bpm (tachycardic)
• Respiratory Rate: 38 breaths/min (tachypneic)
• Temperature: 37.2°C (98.9°F) (afebrile)
• Blood Pressure: 108/72 mmHg
• SpO2 on Room Air: 91% (hypoxemic)
• Pain: 4/10 (chest tightness)
Immediate Action: Placed in Room 4, started on supplemental O2 via nasal cannula at
2L/min.
History of Present Illness
Lucas is a known asthmatic diagnosed at age 5. According to mother:
• Onset: Woke with dry cough and mild shortness of breath this morning
• Triggers: Attended birthday party yesterday at friend's house with cat (known cat
allergy). Weather has been chilly/damp.
• Progression: Symptoms worsened at school → teacher called mother at 13:00 →
albuterol MDI given at 13:15 and 13:45 with spacer → minimal improvement
• Severity: Unable to speak in full sentences, too breathless to run/play
• Associated Symptoms: Non-productive cough, chest tightness, fatigue. No
fever/vomiting.
Past Medical History & Medications
, • Diagnoses: Persistent Asthma (moderate severity)
• Allergies: Cats, dust mites, ragweed (environmental). NKDA.
• Current Medications:
o Controller: Fluticasone propionate 110 mcg, 2 puffs BID (last dose this
morning)
o Rescue: Albuterol MDI 90 mcg, 2 puffs every 4-6 hours PRN
• Prior Hospitalization: One asthma admission at age 6, no ICU admissions
• Immunizations: Up to date
Social & Family History
• Social: Lives with mother and younger sister. 4th grade student. Plays soccer
(sometimes uses albuterol pre-game). Non-smoking household.
• Family History: Mother with asthma/allergic rhinitis. Father with eczema.
Physical Examination Findings
General: Anxious, sitting upright, tripod positioning, respiratory distress
Vitals on O2: HR 128, RR 36, SpO2 94% on 2L O2, Temp 37.1°C
HEENT: Mild perioral cyanosis, nasal flaring
Respiratory:
• Inspection: Intercostal and subcostal retractions, prolonged expiratory phase
• Palpation: Symmetrical chest expansion
• Percussion: Hyper-resonant throughout
• Auscultation: Diffuse high-pitched expiratory wheezes, markedly diminished
breath sounds at right base, coarse rhonchi
Cardiovascular: Tachycardic, regular, no murmurs, capillary refill 2 seconds
Abdomen: Soft, non-tender, uses abdominal muscles for expiration
Diagnostic Assessment
Bedside Testing:
• Peak Expiratory Flow: 45% of personal best (250 L/min → 112.5 L/min)
• Venous Blood Gas: pH 7.32, pCO2 48 mmHg, HCO3 24 mEq/L (acute respiratory
acidosis)
Imaging:
, • Portable CXR: Hyperinflated lungs with flattened diaphragms. No
consolidation/pneumothorax.
Labs: CBC with differential pending
Severity Classification & Diagnosis
Primary Diagnosis: Acute Severe Asthma Exacerbation (Status Asthmaticus)
PRAM Score: 8/12 (Severe) initially → 4/12 (Moderate) after treatment
Key Findings Supporting Diagnosis:
• Known asthmatic with failed home rescue treatment
• Physical exam showing respiratory distress with wheezing/diminished breath
sounds
• Objective: SpO2 91% RA, PEF 45%, VBG showing respiratory acidosis
• CXR: Hyperinflation without complications
Emergency Department Management
Phase 1: Initial Stabilization (First Hour)
1. Oxygen Therapy: Upgraded to simple face mask at 10-15 L/min (target SpO2
>94%)
2. Bronchodilators:
o Albuterol 2.5mg + Ipratropium 0.5mg nebulizer STAT
o Albuterol 2.5mg nebulizer every 20 minutes × 3 doses (back-to-back)
3. Systemic Corticosteroids: Prednisolone 60mg PO STAT (2 mg/kg dose)
Phase 2: Response Assessment
After 1st Nebulizer (15:15): Slight improvement, ongoing distress → ordered back-to-
back nebulizers
After 3rd Nebulizer (16:15): Significant improvement:
• Speaks in full sentences
• Wheezing decreased to moderate intensity
• Retractions decreased
• PEF improved to 65% personal best
