It is January & the height of the flu season. Mrs. Gibbs brings Tommy, age 8, to the local Urgent Care Center. He has a history of Asthma, diagnosed at age 4. He has no other medical problems. He is up to date on all immunizations & received the flu vaccine in October. The COVID Vaccine is not approved for children yet. Mrs. Gibbs reports that Tommy has had a fever, cough, chills, & general malaise for 2 days.
He has an albuterol inhaler that he uses as needed & a nebulizer machine at home. He takes no other medications.
Tommy used the albuterol nebulizer several times yesterday & then last night the nebulizer didn’t seem to help. Mrs. Gibbs put Tommy in the shower & the steam of the shower helped. But this morning he was short of breath, wheezing & having a hard time talking.
Of note both Mr. & Mrs. Gibbs are cigarette smokers.
Vital Signs: BP 130/72, HR 142, RR 38, POX 87% RA, Temp 98.6, Weight 110 lbs (50 kg)
Physical Assessment: Neuro A & O x3; Lungs breath sounds diminished, faint expiratory wheeze; Heart sounds regular, tachycardic, S1,S2, no murmurs appreciated; Abd soft, nontender, non-distended, bowel sounds +; Extremities PP+, no edema.
A rapid COVID-19 test was negative for the coronavirus. The Health Care Provider asks the nurse to place Tommy on nasal 02 & titrate to POX of 92% & if needed to maintain adequate POX use non-breather mask, obtain IV access & routine labs, place on the cardiac monitor, & give an albuterol nebulizer treatment stat & solumedrol 100 mg IV stat.
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