Respiratory distress, wheezing


• Scene – none

• En Route – O2, duoneb, vitals

• Hospital – unknown


• Response to treatment – responded well to duoneb. Became more alert and said he felt a little better. 02 sat improved slightly.

• Transport to pediatric emergency department.


Elliot Williams, Paramedic Woodburn Ambulance

Andrew Hookland, Paramedic Woodburn Ambulance Service


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Respiratory distress
• Asthma exacerbation

Differential Diagnosis

• Asthma exacerbation

• Croup

• Foreign body

• Pneumonia

Patient Workup History

• Caregiver states – Mom was awakened by patient early this a.m. with respiratory distress and coughing fits to the point of vomiting three times.

• Gave 2 inhaler puffs and a duoneb at home before coming to immediate care.

• Wheezing found on exam at immediate care. Gave another duoneb treatment and called for transport for higher level of care.

Physical Exam

• Tired, work of breathing, wheezing, intercostal retractions, nasal flaring, paradoxical abdominal breathing.

• GCS – 15

• EKG – n/a

• Sat-94-96% room air (with 2 albuterol inhaler tx, and 2 duoneb tx PTA)

• 98-100%RA after duoneb en route to hospital

Editor’s Notes

While this child’s quietness may appear reassuring, it could be an ominous sign if the child had more significant distress or respiratory failure. It’s difficult to discern the degree of respiratory distress in this case. Taking the child’s shirt off and watching for movement of the chest wall would help. The oxygen saturation of 97% on room air is somewhat reassuring.-David Spiro, MD This video was taken after duoneb was given in medic.

-Elliott Williams, Paramedic


• Gender: Male

• Age: 3 years

• Height: Not Available

• Weight: Not Available


• Temperature: 99.2 F/37.3 C

• Blood Pressure: Not Available

• Heart Rate: 130

• Respiratory Rate: 50

• Pulse Oximetry: 94-96% RA

Signs and Symptoms

Respiratory distress; wheezing; intercostal retractions; vomiting.

History Medical

• PMH: Asthma

• Allergies: None

• Dispath info: Difficulty breathing, transfer to pediatric emergency department.


• Lives with parents and 2 siblings; infant sibling has a cough, as reported by mom.


• Duoneb (albuterol/ipratropium) and O2 (neb mask 6Lpm)

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