Scenario — Acute asthma exacerbation in a child at a school carnival

foundation Respiratory · Pediatric · 8yr · female

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

Scenario Progression and Treatment Objectives

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: 'EHS volunteers are authorised to administer salbutamol via MDI and spacer only — nebulised route is outside EHS scope.')
! (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.
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 (Priority 1 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 Priority 1 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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Signs/Symptoms	Wheeze, chest tightness, cough, shortness of breath, unable to speak in full sentences.
Allergies	NKDA. No known food or environmental allergies.
Medications	Ventolin (salbutamol) MDI — carries her own blue reliever puffer. No preventer medication currently prescribed.
Pertinent History	Known asthmatic since age 5. No prior ICU admission or intubation. No ED visit in the past 12 months. Has not used her puffer today.
Last Oral Intake	Lunch approximately 2 hours ago — sandwich and water.
Events Leading	Mia was competing in the sack race at the school carnival when she began coughing and felt her chest get tight. She stopped and was walked to the FAP by a teacher.
Treatment Prior	Nil. Mother was not present. Bystander brought Mia straight to the FAP.

Onset	Acute onset approximately 10 minutes ago during the sack race.
Pain	Chest tightness. Non-cardiac. No pleuritic or sharp component.
Quality	Tight, constricting feeling across the chest.
Radiates	Nil
Severity	6/10