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Child with respiratory distress

Clinical Discipline(s)/Organ System(s)
Paediatrics, Respiratory System, Emergency Medicine
Progress Test Topic(s)
Child health
Description
A 2 year old Māori boy presents to the Emergency Department with a 2 day history of coughing. He has a low grade fever, rapid breathing and audible wheeze. He is with two female caregivers. This is his fifth attack of cough and wheeze.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the respiratory system
   - Fetal development of the respiratory system and congenital anomalies
   - Pathogenesis of asthma
   - Pharmacology of asthma medicines including salbutamol, salmeterol, ipratropium, cromoglicate, montelukast, and inhaled steroids (beclamethasone, budesonide, fluticasone)
   - Pharmacology of adrenaline inhaled for acute respiratory distress (croup)
   - Pharmacology of antibacterials used in respiratory infection (benzylpenicillin and associated betalactams cephazolin, cefuroxime), macrolides (erythromycin, azithromycin)
Clinical and Communication Skills 
   - Immediate assessment of the sick child (severity of the respiratory distress and signs of impending respiratory failure)
   - Basic cardiopulmonary resuscitation (CPR) and the choking child
   - History from parent/carer; recognise the differences in history taking when dealing with children; document immunisation status
   - Detailed examination of respiratory system including assessment of acute and chronic disease and cardiovascular examination
   - Important differentiation of signs of upper airway obstruction versus lower airway obstruction in a child
   - Assessment of growth and normal development of child
   - Differential diagnosis of respiratory distress in young child
   - Radiologic features of pneumonia
   - Management of acute asthma: asthma medications, using a spacer, long-term prevention, lifestyle changes, asthma management plan
   - Management of acute respiratory illness due to infection
   - Importance of information/education, need to consider health literacy needs of patient and family/whānau
   - Recognise the signs and symptoms of vaccine preventable disease including measles, pertussis and pneumococcal disease
Personal and Professional Skills 
   - Non-judgemental attitude to history of events
   - Evaluating social history - lifestyle, housing, number of prior Emergency Department presentations
Hauora Māori 
   - Appropriate engagement with whānau including facilitating access to cultural support
   - Health disparities for young Māori children; high respiratory disease burden in children aged under 5 years
   - Awareness of health care disparities; e.g. tendency for medical practitioners to underprescribe preventer inhalers for Māori children with asthma and conscious attempt to avoid delivering poorer quality care
   - Differential health literacy
   - Understanding the barriers to care that whānau face such as impact of caring for sick child for working parents
   - Ethnic differences in risk factors for respiratory conditions including inequities in immunisation coverage by ethnicity, warm housing and smoking rates
Population Health 
   - Epidemiology of acute respiratory illness in children
   - Epidemiology of asthma
   - Normal age-appropriate immunisation schedule
   - Health problems that disproportionately affect Māori; socio-economic deprivation and other factors (e.g. poorer access to and quality of health care)
   - Importance of smoking cessation in the household
   - Housing as a determinant of health; overcrowding, quality of the indoor environment
   - Community management of asthma
Conditions to be considered relating to this scenario
Common
upper respiratory tract infection (including croup), lower respiratory tract infection (including pneumonia and bronchiolitis), viral-induced wheeze, asthma
Less common but 'important not to miss'
aspiration of foreign body, whooping cough
Uncommon
congenital lung abnormality, congenital cardiovascular abnormality, epiglottitis
Related Scenarios
[Neonatal stridor]