Acute asthma exacerbation in elderly male

Patient Information

Dispatch: You are called to a 75YO male at the First Aid Post during the Perth Royal Show. Bystanders report he has been coughing and struggling to breathe for the past 10 minutes. (Ray Hutchinson)
Patient: Ray Hutchinson — 75yr (75kg)
Incident History: Pt was walking through the showgrounds when he developed sudden onset wheeze and shortness of breath. A bystander escorted him to the FAP. Pt states he has asthma and left his puffer at home.
Emergency Contact: Margaret Hutchinson (Wife) — 0412 883 547

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil airway obstruction. Nil stridor. Audible wheeze on expiration.
Breathing: Increased work of breathing. Accessory muscle use noted. Unable to complete sentences in one breath. RR 26/min. Audible expiratory wheeze bilaterally.
Circulation: Radial pulse present — rapid and regular. Skin pale and slightly diaphoretic. Nil bleeding.
Disability: GCS 15 (E4V5M6). Orientated to time, place and person. Anxious.
Exposure: Nil rashes or visible injuries. No medical alert bracelet noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	91% (RA)	Moderate	26	108	148/88	<2s	15	4 4 ++	36.8	–	3
10 mins	95% (O2 simple mask 6L/min)	Mild	20	98	142/84	<2s	15	4 4 ++	36.8	–	2

History Taking

Treatment Response

Diagnosis

This patient is suffering from a moderate acute asthma exacerbation.

Facilitator Triggers — if trainees miss a critical step

! (If oxygen is not applied within 3 minutes of arrival, SpO2 drops to 89% and the patient becomes more distressed and agitated — prompt trainee: 'He looks worse, what do you want to do?')
! (If trainee does not sit the patient upright and instead lays him flat, patient reports feeling more breathless — redirect: 'He says lying down makes it worse.')
! (If trainee does not source a Ventolin MDI and spacer from the FAP kit, remind them: 'What medications do you have available at the FAP?')
! (If trainee asks about the patient's own puffer, confirm he does not have it — EHS must use the FAP-supplied Salbutamol MDI and spacer.)
! (If 10-minute vitals are not reassessed after Salbutamol, prompt: 'It has been 10 minutes — how is he responding to treatment?')

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — confirm patent airway with audible wheeze, moderate respiratory distress, and adequate circulation.
3 Position patient sitting upright or in a position of comfort — do NOT lay flat.
4 Apply oxygen via simple face mask at 5–8 L/min — titrate SpO2 to target 92–95% for adults.
5 Perform Vital Sign Survey — record RR, SpO2, HR, BP, GCS, pain score.
6 Determine severity of asthma exacerbation using the severity classification table — classify as moderate based on accessory muscle use, inability to complete sentences, and SpO2 91%.
7 Assess for risk factors associated with increased risk of asthma-related death — nil high-risk features identified in this patient.
8 Administer Salbutamol (Ventolin) 400–1200 microg (4–12 puffs) via MDI and spacer — indication: bronchospasm in acute asthma. Administer one puff at a time, instruct patient to take 4 breaths per puff. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
9 Reassess SpO2, RR, and respiratory effort after Salbutamol — repeat every 20 minutes for the first hour if required.
10 Record full observations every 10 minutes.
11 Arrange transport to hospital — this patient requires ED review even if symptoms improve.
12 Monitor persistently for rapid deterioration to severe or life-threatening exacerbation.
13 Scenario ends on arrival of ambulance and IMISTAMBO handover.
14 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Asthma exacerbation · Salbutamol Sulphate · Oxygen · MDI & Space Chamber · Primary Survey · Pulse Oximetry

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