Observe him for a few hours

You explain to the parents that salbutamol take some time to work, usually a few hours, so it would be wise to wait a few hours to see its effect.

You say you will be back to review him in 3 hours.

After 4 hours you return to see him again.

Jack is probably a little worse than before. His parents offered him a bottle of milk, but he refused this.

You decide to examine him.

HR 145/min, RR 45/min, T 37.4 C, SaO₂ 93% in Oxygen.

His chest recession is no different to how it was initially and it is easier to hear his respiratory noise at rest. When he coughs, his cough is still very loud.

His chest remains clear and breath sounds are equal.

The parents are worried that he is not getting any better.

What would you like to do next?