We saw the video clip of a nine month old who was admitted with breathing difficulty for 24 hours.

The clinical signs of cough, wheeze, respiratory difficulty with flaring ala nasi, eczematous rash on face, use of nebuliser was picked by all.

However evidence of child deteriorating during the treatment with nebulised medication was not noted by all, one comment was they felt the video had been reversed.

No one commented on the loud alarm going on during the second part of the video when child looked very tired, pale and flopped back on his father.

History: of onset – sudden or gradual, previous such episodes, Family history of Asthma and Examination of chest for air entry and added sounds would have help reach a diagnosis from a common differential of 3-4 common causes.

In management – ‘Routine’ bloods, ABG, electrolytes were request by many – few mentioned ABC

Pricking a child is painful and technically an assault. We all do it but think about it.
Learning points:

• Airway – Breathing – Circulation – take priority over any other test or treatment!
• Get support – Anaesthetist, ENT or Resus team.
• Do NOT subject child to any painful procedure that may precipitate respiratory arrest.
• Inform your Consultant – at the earliest possible time
• Nothing as ‘Routine’ in patient care.
• Investigations have to be with a specific aim – support or refute a working diagnosis or differential
• Watch video meticulously – do not ‘Sleep watch’. Sequence of events will affect management decisions.
• Look out for visual and audio cues in the clip.
• Summarise in an orderly sequence.
• If you do not say it – It has not been observed / noted.

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Anil Garg