Managing pediatric asthma exacerbations in the ED.

Jonah Preston, a five-year-old boy with a history of asthma, was brought to triage by his mother early one morning with a chief complaint of “difficulty breathing.” (This case is a composite based on our experience.) Ms. Preston reported that her son had recently been sneezing and had a runny nose. Over night, he’d begun to cough, finally waking her at 5 am complaining that he couldn’t breathe. He’d had a fever of 101.8°F (38.8°C) and needed albuterol neb ulizer treatment every two hours that morning. Ms. Preston called her child’s pediatrician for advice. The pediatrician referred her to our ED for a chest X-ray and evaluation.