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8 year old with known asthma comes in with 4 days of cough and runny nose, itchy eyes. Parents have been giving him Ventolin 4 puffs Q3h via spacer but are finding this is not working anymore. He is on Flovent BID. They are in the middle of home renovations. He has intermittent vomiting. The child comes in with tachypnea, borderline low sats (~93%), looks pale, audibly wheezing with indrawing. Treatment is initiated and should follow the BCCH asthma pathway. Child will become worse and will ultimately need to be admitted on ketamine infusion and NIPPV.

Educational Goal

Recognition of status asthmaticus, avoid intubation.



  1. Understand and use the PRAM scoring to guide use of BCCH emergent asthma management protocol.
  2. Recognize the severe asthmatic who is refractory to usual therapies and know when to institute NIPPV.


  • Bedside approach to the pediatric patient is different than the adult patient.
  • Locate resources to help with pediatric emergent conditions management.
  • Know who else to call for help if local support unavailable.
  • Understand locally available resp. supports for pediatrics.


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