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Home / Station 15: Child with severe wheeze and respiratory distress

NAC OSCE preparation

Station 15: Child with severe wheeze and respiratory distress

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Child with severe wheeze and respiratory distress

11 minutes

Discipline: Pediatrics
Station type: Assessment + management
Setting: Emergency department

Your task

Take focused history from the parent and state immediate management. Examination findings are provided.

Information available at entry

HR 142/minBP 104/64 mm HgRR 38/minSpO₂ 89% room airT 37.3°C

Coach prompt: Recognize life-threatening pediatric asthma and stabilize first.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 15 of 30

Standardized-patient profile

NameLiam

Age6 years

Pronounshe/him

RoleFather provides history

Demeanour: Child upright, frightened and barely speaking.

Opening statement: “His father says he has been wheezing since last night and now can barely speak.”

History and standardized-patient responses

Current episode

Candidate explores	Standardized-patient response
Trigger	Started after cat exposure; worse overnight.
Severity	One- or two-word speech and unable to walk.
Reliever	Six salbutamol doses with little benefit.
Alternatives	No fever, hives, swelling, vomiting or choking.

Past risk

Candidate explores	Standardized-patient response
ICU	ICU admission last year; never intubated.
Recent	Steroid one month ago; two ED visits this year.
Controller	Frequently misses inhaled corticosteroid.

Exposure

Candidate explores	Standardized-patient response
Smoke	Parent sometimes smokes in car.

Physical findings

Marked accessory use and recession.
Very poor bilateral air entry with faint wheeze.
Alert but tiring; no urticaria or facial swelling.

Examiner prompts

Severity?

Life-threatening/severe asthma due to hypoxemia, inability to speak, poor air entry and fatigue.

Treatment?

Immediate oxygen, repeated/continuous short-acting bronchodilator plus anticholinergic, systemic steroid, close monitoring and urgent senior/critical-care involvement; consider IV magnesium.

Silent chest?

Minimal wheeze because airflow is critically reduced—not improvement.

Differential diagnosis

Severe asthma
Anaphylaxis
Foreign-body aspiration
Pneumonia
Pneumothorax
Upper-airway obstruction

Investigations

Continuous oximetry and serial assessment
Blood gas if tiring/nonresponsive
Chest radiograph only if complication suspected
Electrolytes in severe intensive therapy

Management

Oxygen and bronchodilator therapy
Systemic steroid
Urgent pediatric/critical-care escalation
IV magnesium/advanced support if refractory
Post-recovery controller and action plan

Communication behaviours

Address child directly at age-appropriate level
Give parent a useful role
Explain quiet chest may be dangerous

Critical safety actions

Do not mistake faint wheeze for improvement
Escalate before exhaustion
Past ICU increases risk

Model closing summary

This six-year-old has life-threatening asthma with saturation 89%, one-word speech, marked work of breathing, poor air entry and fatigue, plus prior ICU admission. I would begin oxygen, repeated or continuous inhaled bronchodilator plus anticholinergic and systemic steroid immediately, call senior pediatric/critical-care support, monitor continuously and consider IV magnesium if response is inadequate.

Common pitfalls

Full chronic history before treating hypoxemia
Forcing peak flow
Delayed steroid
No reassessment

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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