PALS Megacode 5 Out-of-Hospital

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You are a healthcare provider working on an ALS ambulance. You are dispatched to the home of an 11-year-old male who has been experiencing increased respiratory effort. You are advised that the patient has a history of asthma and recurrent pulmonary infections. They are currently on ciclesonide INH twice daily and albuterol INH as needed. Albuterol x2 was used 20 minutes ago with no signs of improvement. Your response time to the scene is 3 minutes. Upon arrival, you observe the patient sitting at the house entrance, leaning forward in the tripod position. Both parents are present. A rapid initial impression (ABCs) reveals the following:

  • Appearance: Alert but unable to speak, focused on breathing
  • Breathing: Increased effort, accessory muscle use, wheezing
  • Circulation: Pale skin
1. The information provided by dispatch combined with an initial impression reveal that the patient is experiencing an acute asthmatic exacerbation. How would you classify the intensity of the exacerbation?*