Nebulised adrenaline

You prescribe some adrenaline via nebulizer and this is given to Jack. He objects to the nebulizer but you help his parents hold it in position while it is delivered and tell them that as he cries, it helps bring the medicine into the lungs.

The medicine seems to work and his parents note that he is much better after the nebulizer.

At the end of the nebulizer you review him.

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.

 You suggest that they let him eat and drink as he would like and that you will be back to review him in 3 hours.

After 2 hours you are called to see Jack again. Although he improved quite a bit after the nebulizer, he is probably worse than he was before he came in.

HR 165/min, RR 45/min, T 37.5 C, SaO₂ 91% in air.

He is upset, with moderate chest recession and an audible breathing sound when he takes a breath in.

What would you like to do now?