Acute Asthma Exacerbation in a Child: A Case in Emergency Medicine

Liam, a 7-year-old boy with a history of asthma, presents to the emergency department with a 2-day history of worsening cough and shortness of breath. His mother reports that he has been wheezing and unable to play outside. He has not used his reliever inhaler recently. On arrival, he is sitting upright, leaning forward, and using accessory muscles to breathe. He appears anxious and can only speak in short sentences. Initial vital signs: pulse 140, respiratory rate 40, SpO2 90% on room air, temperature 37.5°C. You are the medical student on duty. Please assess and manage this patient.

By the end of this case, the learner will be able to: 1) Assess the severity of an acute asthma exacerbation in a child using history, physical examination, and objective measures. 2) Initiate appropriate first-line treatment including inhaled short-acting beta-agonists, oxygen, and systemic corticosteroids. 3) Recognize indications for adjunct therapies such as ipratropium bromide and magnesium sulfate. 4) Identify signs of impending respiratory failure and escalate care appropriately. 5) Plan safe discharge and follow-up for a child with asthma.