Discharge and review in clinic

Jack’s parents are pleased to be discharged and look forward to seeing you in the clinic. A slot has been arranged for the next day. Jack is still coughing, and has refused some milk.

His parents say that if he doesn’t improve they will come back. Otherwise they will see you in clinic to take things forward.

The next day you are running the children’s rapid access clinic. The clinic nurse calls you to see one of the patients in the waiting area. It is Jack, and he looks considerably worse than the day before.

He is slightly cyanosed, with marked increased work of breathing.

His parents say that he has recently got worse after a fairly stable night.

You put out a ‘crash’ call and the arrest team come to outpatients. They give him oxygen, intubate him and move him to PICU.

Later that day he undergoes a bronchoscopy and a small plastic toy (Lego®) is removed from his right main bronchus.