Repeat nebulized adrenaline

You prescribe a second adrenaline nebulizer. Jack’s parents are unhappy that he is needing a second one, but agree that the first one was very effective. Jack is upset again by the nebuliser and again attempts to push the mask away. His father holds it on tight at your instructions.

Again Jack improves but less so than with her first nebulizer. After the nebulizer is finished you reassess him:

HR 175/min, RR 33/min, T 37.3 C, SaO₂ 94% in Oxygen.

His breathing has only mild sternal recession and soft added breathing sounds at rest.

One hour later he is deteriorating again and you decide to call the team from paediatric intensive care who attend quickly. They review him and are concerned about his airway. A cannula is sited and he is given intravenous dexamethasone and he is taken to PICU.

You hear later that he was intubated because of his breathing difficulty.