You are rostered to an afternoon shift 1300-2300 working with another ACP2 officer. You have completed your pre-shift checks when your first job comes through.

You are dispatched to a 16-year-old male complaining of shortness of breath, your patient is located in the sickbay of the local high school.

On arrival you are escorted by a teacher to the sick bay, there is no obvious danger. The teacher explains the patient was participating in PE when he became short of breath. The patient used his own Ventolin puffer with limited effect and QAS was subsequently called. The patient’s name is Jack.

On examination you see your patient is sitting up on the edge of the sick bay bed, your patient appears extremely anxious, pale and sweaty. The patient’s eyes are closed, and they open when you introduce yourself, but hey close again when you stop talking. The patient can only speak to you in single words.

Your partner provides the following observations:

HR: 120 regular
BP: 100/60
SpO2: 88% Room Air Temp: 36.8 Tympanic BGL: 6.8mmol/L

You note the patient’s respiratory rate to be 30 breaths/minute, with a prolonged expiratory phase, and you note a tracheal tug, he is sitting in the tripod position and using accessory muscles. On auscultation you hear high pitched inspiratory and expiratory wheezes.

When you speak to the patient their eyes open, they can squeeze you hand when you ask and they can answer your questions, but in single words only. The patient is orientated to time, place and situation. The teacher hands you a document that tells you the patient has a history of asthma, current medications are Ventolin inhaler as required, and no known allergies. The patient states they have never been hospitalised for asthma before.

Based on the above information:

1) What is your provisional diagnosis?
2) Provide a brief definition for your provisional diagnosis.
3) Provide a detailed explanation of the pathophysiology for your provisional diagnosis.
4) Outline your immediate and ongoing management for this patient.
5) Provide three possible differential diagnoses for this patient and explain how you would rule them out, based on the patient presentation and underlying pathophysiology.

6) Provide a handover to a senior clinician using the IMISTAMBO format.