Bronchiolitis in a young child at community fair

Patient Information

Dispatch: You are called to the First Aid Post at the Mundaring Community Fair for an 8-year-old male (Lachlan Trevorrow) brought in by his mother. She is concerned he has been coughing and wheezing for the past two days and is now struggling to breathe.
Patient: Lachlan Trevorrow — 8yr (26kg)
Incident History: Mum states Lachlan has had a runny nose and low-grade fever for the past two days. Over the last few hours his breathing has worsened — he is breathing faster than normal, has a persistent wet cough, and is wheezing. No known asthma. No previous episodes like this.
Emergency Contact: Sharon Trevorrow (Mother) — 0412 774 093

Initial Rapid Assessment

Response: Alert
Airway: Patent. No foreign body. Mild secretions audible. No stridor. No drooling.
Breathing: Increased work of breathing. Audible expiratory wheeze bilaterally. Intercostal and subcostal recession visible. Nasal flaring present. RR 38/min. SpO2 91% on room air.
Circulation: Radial pulse present, rapid. Skin warm and slightly pale. CRT 2 seconds. No cyanosis at rest.
Disability: GCS 15 (E4V5M6). Alert, anxious. Orientated to person. Mum present providing comfort.
Exposure: No rashes. No urticaria. No visible injuries. Mild intercostal recession visible on chest exposure. Low-grade temperature on touch.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	91% (RA)	Moderate	38	128	96/62	2s	15	3 3 ++	38.1	–	2
10 mins	95% (O2 simple face mask 6L/min)	Mild	32	118	98/64	2s	15	3 3 ++	38.1	–	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from an acute exacerbation of bronchiolitis presenting with moderate respiratory distress, wheeze, tachypnoea, and hypoxia in an 8-year-old male. Note: the CPG explicitly states that asthma is uncommon in children under 12 months of age and that wheezing in that age group is more likely bronchiolitis — however, this patient is 8 years old and presents with wheeze and respiratory distress. EHS officers should recognise that the diagnosis here is clinically consistent with either asthma exacerbation or bronchiolitis, but that EHS scope of practice limits treatment to supportive oxygen therapy and urgent transport. Salbutamol via MDI is listed as Intermediate Care and above for asthma exacerbation in the CPG. EHS officers cannot administer salbutamol and must focus on oxygen titration, positioning, reassurance, and urgent transport.

Facilitator Triggers — if trainees miss a critical step

! (If trainees attempt to administer salbutamol via MDI — facilitator advises: 'Salbutamol administration is Intermediate Care and above per the Asthma CPG. As an EHS officer, this is outside your scope. What else can you do for this patient?')
! (If oxygen is not applied within 3 minutes of assessment — SpO2 drops to 88% on room air and Lachlan becomes visibly more distressed, intercostal recession worsens, and he begins to cry.)
! (If trainees attempt to force Lachlan into a supine position — mum states he is more comfortable sitting up. Facilitator notes: the CPG advises 'Do not forcibly change a child's posture; they will adopt the posture that minimises airway obstruction.')
! (If BGL is not considered in an altered or deteriorating paediatric patient — facilitator prompts: 'What baseline observations would you want to complete on a paediatric patient with altered breathing and a fever?')
! (If trainees do not request ambulance early — at 5 minutes, Lachlan's SpO2 remains at 91% on room air and he becomes more fatigued. Facilitator prompts: 'How are you going to escalate care for this patient given your scope limitations?')

Treatment Objectives

1 Ensure scene safety and don appropriate PPE including consideration of respiratory precautions given infectious presentation.
2 Perform Primary Survey — confirm patent airway, assess breathing effort, circulation, disability (GCS), and exposure.
3 Position Lachlan in a position of comfort — seated upright as adopted by the child. Do NOT forcibly change posture.
4 Apply continuous reassurance to both Lachlan and his mother throughout.
5 Apply pulse oximetry monitoring to assess SpO2 — initial reading 91% on room air.
6 Administer oxygen via simple face mask at 5–8 L/min targeting SpO2 ≥95% for paediatrics as per CPG. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
7 Reassess SpO2, RR, and work of breathing after oxygen application.
8 Complete Vital Sign Survey — RR, HR, BP, SpO2, temperature, BGL if indicated, pain score.
9 Take IMISTAMBO history including: S&S, onset, medications, allergies, PMHx, last oral intake, prior treatment, and events leading.
10 Recognise moderate respiratory distress: intercostal recession, nasal flaring, RR 38/min, SpO2 91% RA — classify as Moderate per the Asthma/Dyspnoea severity table.
11 Recognise that salbutamol administration is OUTSIDE EHS scope (Intermediate Care and above per Asthma CPG) — do NOT administer.
12 Request ambulance (urgent ambulance) early given moderate respiratory distress in a paediatric patient with hypoxia not fully corrected on initial assessment.
13 Prepare for deterioration — have BVM and suction available at bedside.
14 If Lachlan deteriorates (SpO2 <90% or GCS drops), be prepared to assist ventilations via BVM at a rate appropriate for an 8-year-old (approximately 12–20 breaths/min).
15 Continue monitoring full observations every 10 minutes (or 5 minutes given time-critical status).
16 Provide warm reassurance to mum — explain what you are doing and why ambulance is being called.
17 Scenario ends on arrival of ambulance and IMISTAMBO handover.
18 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Asthma exacerbation · Dyspnoea & Respiratory Distress · Oxygen Delivery · Primary Survey · Bag Valve Mask Ventilation

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