Who you are:
You are an FY2 in A&E.Who the patient is:
Ashley Young the mother of Josh Young, who is 5-years-old has put on a standby call to the Emergency Department.What you must do:
Talk to mother address her Concerns and initiate an initial line of Management
Note: This is a Telephone conversation
Approach
Telephone GRIPS & Paraphrase
- Can you confirm George’s date of birth?
- Can you confirm the first line of your address?
Presenting Complaint
- Mother shouting “my son can’t breathe”
- Acknowledge her concerns.
- Try as much as possible to calm the patient. ‘Please, I’ll need you to calm down so that you will be able to help Josh better, I’m here to help u.’
- The ambulance is going to be on its way to your house immediately, reassure her.
History
- Where is your son at the moment?
- What happened to him?
- Was he playing with toys before this happened?
- Check Airways by checking the mouth
Medical Condition
- Is he being managed for any medical condition? Asthma
- Is he on inhalers?
- Do you have the inhalers there? (Tell her to sit the child upright on the couch, prior to administration) Please give him 2 puffs. You can give up to a maximum of 10 puffs.
- Always ask how the child is doing after each puff. Keep reassuring by saying that ambulance is on the way.
- Has he been unwell in the last few days?
- Any fever?
- Any cough?
- Do you have any pet at home?
- Any flu-like symptoms
- Any vomiting?
- Dr, he is struggling to breath again. I’m so sorry please take a deep breath. Please Give him another 2 puffs now. The ambulance is already on its way and I’m here with you
- Give him 2 puffs of his inhaler now.
Continue History Taking
- PAMGUDU(one Q in each, explore +ves)
- Keep alternating reassurance and meds (2 puffs at a time up to a max of 10 puffs)
Management at Hospital
- When he arrives at the hospital, I’m going to examine him, his chest, I’ll be doing this in the presence of the chaperone and ensure his privacy
- From what you told me and from the examination findings (may be given in the cubicle) I suspect he is having what we call acute exacerbation of asthma, likely from a Chest infection
- Oh he’s having difficulty breathing again… Reassure and continue
- This is actually an emergency so we will admit him when he gets here
- We’ll do routine blood tests, (FBC. EUC, LFT ABG) & chest X-ray
- Give oxygen (where necessary)
- We will give him a special medication called nebulised salbutamol and it will really help with his breathing
- He’ll be given paracetamol
- Give antibiotics based on the hospital protocol (if you suspect a chest infection)… ensure to ask about allergies. If allergic to penicillin: You mentioned that he’s allergic to penicillin, we will be giving him an antibiotic other than the penicillin he’s allergic to according to the hospital protocol.
- I will inform my seniors as well so they can see him when he gets here
- Keep reassuring & addressing concerns