The Unhappy Wheezer

Author: Anna Mary Moore / Editor: Ronan O’Sullivan / Reviewer: Steve Corry-Bass, Haitham Hodhod / Codes: ResC2, ResP2, ResP4, SLO5 / Published: 17/06/2022

A 5-week-old boy is brought to the PED by his parents. He has had nasal congestion, cough and wheeze for 3 days. In the past 12 hours he has become lethargic and is only taking half his usual volume of formula. His parents describe one apnoeic episode. He has no fever. He was born at 37 weeks gestation and had no perinatal problems.

On arrival he is brought directly to the resus room. He is pale and lethargic and has a feeble cry; he has head bobbing, nasal flaring and marked subcostal and intercostal retractions. Vital signs are: SaO2 85% in room air, 96% on 10 L O2 via non rebreather mask, RR 76, HR 174, CRT 2 secs, T36.8. On auscultation of the chest he has wheeze and crackles bilaterally. He has no murmur and femoral pulses are present. He has no rash. Blood glucose is 5.4. CBG results are pH 7.26, pCO2 8.67, HCO3 24.7, BE 0.8, lactate 1.5.