Date of birth and address confirmed
Consented to view his medical notes

Presenting Complaint

Wheezy cough and fast breathing
Fever following afternoon nap

History of Presenting Complaint

Patient has had coryzal symptoms for the last couple of days with runny nose and sneezing
Developed a cough which was prominent overnight
Cough described as wheezy today
Seen by general practitioner earlier today around midday who listened to his chest and reported it was on the cusp of being normal
General practitioner mentioned a reading of 60 though mother unsure of the parameter measured
Patient had a sleep this afternoon and woke with a temperature
Mother administered Calpol for the fever
Breathing became very wheezy and fast after waking with audible noise on each breath
Intercostal recession noted on inspection of the chest when assessed via telephone triage
Patient has been eating and drinking and had milk at approximately 3 to 3.15 today
Had a wet nappy
Mother primarily concerned about the breathing

Observations

Not discussed

On Examination

Not discussed

Plan

Advised to attend accident and emergency immediately for paediatric assessment
Patient requires urgent chest auscultation and may need urgent antibiotics, investigations, nebulisers or inhalers
Advised nearest accident and emergency with separate paediatric department

Safety Netting

Advised to call back if patient becomes more unwell or develops further breathing problems en route to hospital

Transcript[00:00] S1: Thank you for calling so quickly. No problem. Is that mum too? Harry? Yes it is. Hi, mom. Can I just confirm it's Harry's date of birth is 26 April 25th.
[00:09] S2: Yes. That's right.
[00:11] S1: Okay. And the postcode is n2 LD.
[00:15] S2: Yes. Correct.
[00:16] S1: All right, so tell me exactly. Do I have your permission to view Harry's medical notes?
[00:22] S2: Yes. Okay.
[00:23] S1: Tell me exactly what's happened.
[00:25] S2: So he's had a cold for the last couple of days. Right. Um, yesterday it was just quite runny nose, sneezing. But then he developed a cough. So overnight, he was coughing quite a lot. And today he was coughing. Um, and it was quite like a wheezy cough. So earlier today, at like 12, I took him to a GP who listened to his chest, and she said it was just on the cusp of being normal. She mentioned the figure 60. I don't know if it's 60 beats or I don't know, but that was what she that was the reading from listening to his chest and she said to keep an eye on him. But at that moment, she wasn't like she thought it was fine because he was just just normal. Then he he's had a sleep this afternoon, and then he woke up from his sleep with a temperature. So I gave Cal.
[01:22] S1: All right.
[01:23] S2: He just seemed very hot. But I gave Cal Paul, and then his breathing just sounded very wheezy. So he's breathing quite fast, and it's just quite a wheezy breathing. Like I can hear, like, a bit of a noise every time he takes a breath. Um, and it looks like, obviously with the when we spoke to someone from One-On-One, when we were looking at his chest, and it does look like he's sucking in quite a lot, um, in between his rib cage. Um, and it's quite fast. The breathing. Um, he has had a boss, like, he is kind of eating. Drinking. He had his milk at like three, three, 15. Um, so he had. Yeah. He is kind of eating. Drinking. He had a wet nappy and everything. It's just the breathing that I was a bit concerned about.
[02:14] S1: I think from the way you're describing it, I think you're best to bring him straight to accident and emergency, ma'am.
[02:21] S2: Okay.
[02:21] S1: Yeah.
[02:22] S2: From the fast breathing and stuff. You think the wheezing?
[02:25] S1: Absolutely. Absolutely. I think I think you have to bring him straight to the pediatric doctors. Someone needs to listen to his chest as soon as possible. If he needs an urgent antibiotics or any urgent investigation, he needs to be done urgently. Sounds like it. And if it's wheezing, maybe they need to give some nebulizers or puffs or something and monitor him. This is all something for A&E. I don't even think you should go and see a GP again. We have GP appointments, but I don't think it would be useful.
[02:55] S2: Okay, so you just think the nearest A&E is the Whittington?
[02:59] S1: Whittington is good. Yeah, yeah, Whittington is good. Yeah. Just around the corner. There's a separate paediatrics. Okay. Yeah. Okay. Any problems getting there? If he becomes unwell, further breathing problems or anything like that. Just give us a call. But bring him there now. Yeah.
[03:12] S2: Okay. All right.
[03:13] S1: All right. All right. Thanks a lot. Bye bye.
[03:16] S2: Bye bye.