Nebulized adrenaline

You prescribe an adrenaline nebulizer. Jack’s parents are unhappy that he has to have a second nebulizer, especially as the first one did so little. Jack too is upset by this and attempts to push the mask away. His father holds it on tight at your instructions.

Rapidly Jack improves and within about 5 minutes his breathing is clearly better, with less recession. After the nebulizer is finished, you review him again.

HR 175/min, RR 30/min, T 37.2 C, SaO₂ 96% in Oxygen.

He is still a little upset, but his breathing is notably better with no sternal recession and added breathing sounds.

During the next hours Jack deteriorates again, and so you call the team from paediatric intensive care who attend quickly.

The team are concerned about his airway. They site a cannula and give some intravenous dexamethasone and admit him to PICU. You hear later that he was intubated for his airway concerns.