← Back
Scenario — 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)
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
Signs/Symptoms
Wheeze, shortness of breath, chest tightness, persistent cough.
Onset
Sudden onset approximately 10 minutes ago while walking through the showgrounds.
Pain
Chest tightness only — not cardiac-type pain.
Quality
Tight chest with expiratory wheeze. Cannot finish sentences without pausing.
Radiates
Nil
Severity
6/10 chest tightness
Allergies
Nil known drug allergies.
Medications
Salbutamol MDI (Ventolin) — prescribed, not on his person today. Irbesartan for hypertension. Atorvastatin.
Pertinent History
Known asthmatic for 20 years. Well-controlled at baseline. No prior ICU admissions. No prior intubations. Occasional use of puffer — usually less than one canister per month.
Last Oral Intake
Lunch approximately 2 hours ago.
Treatment
Nil. Does not have his puffer with him.
Events Leading
Pt was walking between pavilions at the Perth Royal Show when he began coughing and felt his chest tighten. Symptoms worsened over 10 minutes.
Scenario Progression and Treatment Objectives

((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?'))

This patient is suffering from a moderate acute asthma exacerbation.

  • Ensure scene safety and don appropriate PPE.
  • Perform Primary Survey — confirm patent airway with audible wheeze, moderate respiratory distress, and adequate circulation.
  • Position patient sitting upright or in a position of comfort — do NOT lay flat.
  • Apply oxygen via simple face mask at 5–8 L/min — titrate SpO2 to target 92–95% for adults.
  • Perform Vital Sign Survey — record RR, SpO2, HR, BP, GCS, pain score.
  • 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%.
  • Assess for risk factors associated with increased risk of asthma-related death — nil high-risk features identified in this patient.
  • 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.
  • Reassess SpO2, RR, and respiratory effort after Salbutamol — repeat every 20 minutes for the first hour if required.
  • Record full observations every 10 minutes.
  • Arrange transport to hospital — this patient requires ED review even if symptoms improve.
  • Monitor persistently for rapid deterioration to severe or life-threatening exacerbation.
  • Scenario ends on arrival of ambulance and IMISTAMBO handover.
  • Attention to hand hygiene will be given throughout the scenario.

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