Acute asthma exacerbation in a child at a school carnival

Patient Information

Dispatch: You are called to the FAP at Claremont Primary School Autumn Carnival for an 8-year-old girl (Mia Nguyen) who is having trouble breathing after running in the sack race.
Patient: Mia Nguyen — 8yr (25kg)
Incident History: Pt was participating in the sack race when she began coughing and complaining of chest tightness. Bystanders brought her to the FAP. Pt has a known history of asthma.
Emergency Contact: Linh Nguyen (Mother) — 0412 338 774

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil obstruction. Nil stridor.
Breathing: Increased work of breathing. Audible wheeze on expiration. Unable to complete sentences in one breath. RR elevated. Accessory muscle use present.
Circulation: Radial pulse present, 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. Nil urticaria.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	91% (RA)	Moderate	28	118	100/65	<2s	15	4 4 ++	37.1	–	3
10 mins	96% (O2 simple mask 6L/min)	Mild	22	108	102/66	<2s	15	4 4 ++	37.1	–	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from a moderate acute asthma exacerbation triggered by physical exertion.

Facilitator Triggers — if trainees miss a critical step

! (If trainee does not sit Mia upright within the first 2 minutes, she begins to lean forward onto her hands and reports feeling more breathless — prompt: 'What position would help this patient breathe more comfortably?')
! (If oxygen is not applied within 3 minutes of arrival, SpO2 drops to 89% on room air and Mia becomes more distressed and tearful.)
! (If the trainee does not administer salbutamol via MDI and spacer, at 8 minutes Mia reports no improvement, wheeze becomes louder, and RR increases to 32 — facilitator states: 'Mia looks at you and says she is not getting any better.')
! (If trainee attempts to use a nebuliser rather than MDI and spacer, remind them: 'Administer salbutamol via MDI and spacer — please set up the MDI and spacer now.')
! (If trainee does not contact the patient's emergency contact or request ambulance backup, facilitator prompts: 'The school principal asks if you need additional resources or if her mother should be called.')

Treatment Objectives

1 Ensure scene safety and don appropriate PPE including gloves.
2 Perform Primary Survey — confirm patent airway, assess breathing severity, assess circulation.
3 Sit Mia upright or in a position of comfort — do not allow her to lie flat.
4 Apply pulse oximetry monitoring.
5 Apply oxygen via simple face mask at 5–8 L/min — titrate to target SpO2 ≥95% for paediatrics.
6 Conduct Vital Signs Survey — RR, SpO2, HR, BP, GCS, pain score.
7 Classify asthma severity — moderate exacerbation (unable to complete sentences, accessory muscle use, SpO2 91%, RR 28).
8 Perform history taking — SAMPLEA including allergy, medications, pertinent history.
9 Administer Salbutamol 4–6 inhalations (400–600 microg) via MDI and spacer — indication: moderate acute asthma exacerbation in a paediatric patient aged 6 years and over. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
10 Assist Mia with correct technique: seal lips around spacer mouthpiece, press MDI once, take 4 slow deep breaths per puff, one puff at a time.
11 Reassess SpO2, RR, work of breathing, and pain score 5 minutes after salbutamol administration.
12 If inadequate response at 20 minutes, repeat salbutamol 4–6 inhalations (400–600 microg) via MDI and spacer.
13 Contact emergency contact (mother Linh Nguyen — 0412 338 774) to inform of Mia's condition.
14 Request ambulance backup (urgent if deterioration; Priority 2 if improving but requires hospital review).
15 Monitor persistently — record full observations every 10 minutes.
16 Do NOT leave Mia unattended. Provide continuous reassurance to reduce anxiety.
17 Prepare for rapid deterioration — have BVM and suction available at bedside.
18 If Mia deteriorates to life-threatening features (reduced consciousness, cyanosis, silent chest, SpO2 <90%), escalate to urgent and manage airway with BVM if required.
19 Scenario ends on arrival of ambulance and IMISTAMBO handover.
20 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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