Practice Guidelines, Managed Care, and Utilization Review
"While you were Wheezing"
You prescribe appropriate medications, and instruct Janie and her grandmother to return for follow up in two weeks. Three months later Janie's grandmother brings her to the Emergency Room for an exacerbation. Now Janie's grandmother has legal custody, and has also recently obtained insurance for Janie under the Children’s Health Insurance Plan. (A low cost insurance available to children whose families do not qualify for Medicaid, but whose annual income is less than 200% of poverty.) Janie is on a managed care program called Texas Starfighters, and you have been identified as her Primary Care Provider (PCP).
Initial evaluation shows Janie alert with a respiratory rate of 44/minutes. She
speaks in short sentences to the examiner and seems mildly anxious. She has 15
mm pulsus paradoxus, and has mild intercostal retractions and appears pale.
Wheezes are present in all lung fields. Oxygen saturation on room air is 92%.
Based upon the this information, how would you assess this Janie’s acute exacerbation of asthma ?
Mild
Moderate
Severe
Respiratory
Arrest Imminent