12 Year Old Asthmatic with Intermittent Dyspnea Unresponsive to Albuterol---What is it, and Why Now?

This case was written by one of ourgreat Hennepin 2nd year residents, Aaron Robinson, with lots of comments and edits by Smith.Thanks to Dr. Smith and Dr. Travis Olives for being part of this case. A 12 year old girl with a history of mild intermittent asthma presented to the emergency department with worsening shortness of breath over the past couple of days. She is up to date on her vaccinations and has no PMHx besides asthma and a noncontributory family history. She does not identify any specific triggers for her asthma. Initial screen in triage revealed normal vitals signs and a normal temperature. Upon interviewing the patient and her mother, they state that the patient has been having worsening shortness of breath in the past week, but her neb treatments (which typically eliminate her issues) haven ' t been working. The child appeared anxious, but overall nontoxic during her initial emergency department evaluation. Her mother had given her two albuterol neb treatments prior to arrival, without improvement. What was puzzling to the emergency physicians was the history and physical. On first glance, things seemed consistent with worsening asthma, but there was something that didn ' t fit. The child didn ' t have any wheezing on exam, but but this was not so unusual in that asthma frequently lacks wheezing. What was more unusual for asthma was that there was also no history of cough, (which is almost universally present in asthma).  It was further diggi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs