Acute asthma exacerbation in a child at a school sports carnival

Patient Information

Dispatch: You are called to the FAP at Hale Primary School Sports Carnival. A teacher has brought in an 8-year-old boy (Lachlan Tran) who is wheezing and struggling to breathe after competing in the 100m sprint.
Patient: Lachlan Tran — 8yr (26kg)
Incident History: Pt was running the 100m sprint when he began coughing and wheezing. Teacher noticed he was struggling to breathe and walked him to the FAP. Pt states his chest feels tight.
Emergency Contact: Mai Tran (Mother) — 0412 774 391

Initial Rapid Assessment

Response: Alert
Airway: Patent. Nil obstruction. Nil stridor. Audible wheeze on expiration.
Breathing: Increased work of breathing. Audible expiratory wheeze. Accessory muscle use visible at neck. Unable to speak in full sentences. RR 28/min. SpO2 91% on room air.
Circulation: Radial pulse present, regular, rate elevated. Skin warm and pink. CRT <2s.
Disability: GCS 15 (E4V5M6). Alert and orientated to time, place and person. Anxious.
Exposure: No rashes or visible injuries. Increased subcostal recession visible on chest wall.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	91% (RA)	Severe	28	118	102/64	<2s	15	4 4 ++	–	–	4
10 mins	96% (O2 simple mask 6L/min)	Mild	20	108	104/66	<2s	15	4 4 ++	–	–	2

History Taking

Treatment Response

Diagnosis

This patient is suffering from a severe acute asthma exacerbation, triggered by exercise, in a child with known asthma.

Facilitator Triggers — if trainees miss a critical step

! (If oxygen is not applied within 2 minutes of assessment, SpO2 drops to 88% and the patient becomes more distressed, unable to speak more than 2-3 words at a time.)
! (If salbutamol is not administered within 5 minutes, the patient's wheeze worsens audibly, RR increases to 32/min, and the patient begins to look exhausted.)
! (If the trainee does not sit the patient upright and instead attempts to lay him down, the patient states 'it's harder to breathe like this' and becomes more agitated.)
! (If the trainee fails to reassess after salbutamol administration, prompt them: 'It has been 5 minutes since the puffer — how is Lachlan doing now?')

Treatment Objectives

1 Ensure scene safety and don PPE.
2 Perform Primary Survey — identify severe asthma exacerbation with SpO2 91% on room air and accessory muscle use.
3 Position patient sitting upright or in a position of comfort — do NOT lay patient flat.
4 Apply oxygen via simple face mask at 5–8 L/min — titrate SpO2 to ≥95% for paediatrics.
5 Perform Vital Sign Survey including SpO2, RR, HR, BP, pain score.
6 Conduct SAMPLE history — confirm known asthma, no puffer available, exercise trigger.
7 Administer Salbutamol (Ventolin) via MDI and spacer: 2–6 inhalations (200–600 microg) for child aged 12 months to 5 years — NOTE: Lachlan is 8 years old (≥6 years), therefore administer 4–12 inhalations (400–1200 microg) via MDI and spacer. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
8 Reassess SpO2, RR, work of breathing and wheeze 5 minutes after salbutamol administration.
9 Repeat salbutamol 4–12 inhalations via MDI and spacer every 20 minutes if required, or sooner if clinically indicated.
10 Record full observations every 10 minutes — document pre- and post-salbutamol respiratory status.
11 Contact CSP for advice if patient does not respond to treatment or deteriorates.
12 Identify risk factors for asthma-related death — reassure if none identified but note no puffer on scene.
13 Call 000 for ambulance — patient has severe exacerbation features (unable to speak in full sentences, SpO2 91%, accessory muscle use).
14 Continue monitoring for deterioration — be alert for silent chest, falling GCS, or exhaustion indicating life-threatening exacerbation.
15 Scenario ends on arrival of ambulance and IMISTAMBO handover.
16 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Asthma exacerbation · Salbutamol Sulphate · Oxygen · MDI & Space Chamber

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