Diagnosis: Asthma exacerbation

Treatment: Inpatient admission, diagnostic evaluation, and medication management.

The insurer denied inpatient admission. That denial was reversed.

The patient has a history of asthma and has had multiple previous asthma admissions to the hospital. The patient has required two steroid treatments in the previous three weeks. The patient also has a history of anxiety and depression which was being treated with Zoloft. The patient was seen in an UrgiCare center 11 days prior to this admission and was diagnosed with sinusitis and she was prescribed azithromycin and prednisone. The patient then developed difficulty breathing, coughing and wheezing and was treated with her asthma relief medication in the home with no improvement. When the child did not improve she was brought to the hospital by her mother for an evaluation.

In the Emergency Room (ER) the child was noted to be in moderate respiratory distress with retractions and increased work of breathing. The child was treated with 3 doses of DuoNeb, steroids, magnesium, and intravenous (IV) fluids with some improvement noted. When the evidence of increased respiratory effort, wheezing and prolonged expiratory phase persisted despite treatment the decision was made to admit the child to the hospital with a diagnosis of status asthmaticus. The plan was to continue treatment with oxygen, IV fluids and albuterol every 3 hours.

The patient was treated appropriately in the ER for status asthmaticus. The decision to admit the patine to the hospital with a diagnosis of status asthmaticus for ongoing treatment with albuterol every 3 hours and steroids was consistent with the standard of care for a child with a history of multiple previous asthma admissions and persistent respiratory distress.