Clinical scenario: A 10-year-old with shortness of breath

You are asked to respond to the soccer field at the local middle school

“Rescue 76, Priority One to Vale Middle School, on the soccer field for a student complaining of difficulty breathing. The coach is advising the patient is in and out of consciousness.”

As you pull up to the school, security waves you through the gate and onto the track surrounding the field. The school’s trainer tells you that Sam was playing in a soccer tournament and while on the sideline during halftime suddenly experienced a hard time breathing. Sam drove to the tournament with another player’s family and his parents cannot be reached by phone.  

As you walk up, you see that Sam is sitting on the grass, bent forward and clearly working hard to breathe. You kneel down in front of him and introduce yourself. Sam looks up, but does not speak. He appears somewhat drowsy. You estimate that he is breathing 60 times a minute and note that his breaths are shallow.

(Image Greg Friese)
(Image Greg Friese)

Your partner listens to lung sounds and tells you “I can’t hear anything.” Sam’s blood pressure is 100/68 with a pulse of 92 and a pulse oximetry reading of 78 percent. You ask Sam’s coach if Sam has any medical problems or takes any medications. The coach replies that he does not know.  

  • What is your suspected differential diagnosis?
  • What are your first steps for treatment?

Post your answers below in the comments!

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