Appreciation for Excellence!  This was the mother of a 17-month-old male calling as the baby had fever and he was breathing “super hard” for the last 2 hours. The mother had given albuterol and cough medicine about an hour before the call, but he was still hot and breathing fast. The baby had a history of being born prematurely and had reactive airway disease. He was wheezing prior to having albuterol per the mother and his skin is sucking in around his ribs. RN asked to listen to the child’s breathing and to count the respirations. Carol asked to listen to the baby’s breathing and stated she heard some wheezing. The patient and the mother were 10 minutes away from the closest ED. Carol stated she would place the mother on hold for 3-5 minutes to consult a CCMD. She gave an accurate and precise SBAR with a recommendation of the ED, due to the intercostal and substernal retractions with audible wheezing, which was approved by the CCMD.  The RN returned to the mother and recommended ED, gave CFI and the call ended.    

The baby arrived at the ED with a pulse of 149, increased work of breathing with subcostal retraction, tracheal tugging, the respiratory rate in the 40s, and end-inspiratory and expiratory wheezes noted in all lung fields. He was started on continuous Albuterol and oxygen support. He was also given Decadron and Ipratropium. The Albuterol was weaned, and he was put on blow by oxygen. His oxygen desaturated to the high 80s, so he was given a bolus of normal saline and magnesium sulfate and was admitted for continuous monitoring and treatment. The baby was Covid, Flu, and RSV negative. He was diagnosed with asthma exacerbation and pneumonia, prescribed Amoxicillin for 10 days and Decadron, and discharged home the next day, where he dramatically improved per the ED follow-up note with the PCP.