Annabelle is a 6 year old girl who has been brought to the Paediatric Emergency Department by her parents. Her parents reported that they dined at a Chinese restaurant for dinner and after returning...

Annabelle is a 6 year old girl who has been brought to the Paediatric Emergency Department by her parents.  Her parents reported that they dined at a Chinese restaurant for dinner and after returning home Annabelle began to have difficulty breathing and appeared red in the face.  Annabelle has a history of peanut allergy and has an Epipen but the parents stated, “We packed it away when we moved house and we haven’t found it yet and she’s never really had any allergic reactions since she was 3 years old.”





When you assess Annabelle, she is flushed in the face and has a reddened raised rash on her arms and abdomen.   She has a hoarse sounding voice and her lips and tongue appear swollen.  She says “I can’t swallow or breathe and I feel dizzy.”  Her respiratory rate is 25 breaths per minute and shallow. Her heart rate is 120 beats/min and her blood pressure is 85/50 mmHg.  Her oxygen saturations on room air are 92%.







 Essay Case Option 2:  Adult with Chronic Obstructive Pulmonary Disease (COPD):
Jim is a 72 year old male admitted to the medical ward this morning with an infective exacerbation of his Chronic Obstructive Pulmonary Disease (COPD).  Jim has a history of smoking since he was a teenager but managed to quit 3 years ago when diagnosed with COPD.  Jim noticed he had been coughing more throughout the night and his sputum had turned a thick green colour.  He has also reported that he had not eaten or drunk much in the past two days as he was feeling so unwell.  As you examine his mouth you note his tongue is white and his lips are cracked and dry.  The urine bottle on the side of his bed contains a small amount of dark amber urine.  Jim’s weight on admission is 55kgs and he is 176cms tall.

He is currently receiving 3rd hourly nebulised ventolin and is on 2L/min of oxygen via the nasal prongs.  His observations are heart rate 90/min, respiratory rate 26, oxygen saturation 92%, temperature 37.8 oC.  He has an IV cannula insitu and  his medical chart shows that he has been prescri