David is a five-year-old male with a known history of asthma since he was an infant. Parents are both non-smokers. The patient had been doing well on his usual medications. He has mild, persistent asthma. His maternal grandparents were visiting from out of town this week and stayed at David's house. They are both heavy smokers and did not always smoke outside as they had been asked. David was

Question

brought to the ED in obvious distress. His parents had tried two breathing treatments at home, without much success, prior to arrival at the ED.

Physical exam in the ED was remarkable for tachycardia (130) and tachypnea. Inspiratory and expiratory wheezes and coarse ronchi were heard on auscultation. His CXR showed moderate infiltrates. His UA was negative. Blood work was WNL. Patient had several nebulizer treatments in the ED, and IV steroids were started. His O2 levels were initially under 90%.

The patient was admitted for further treatment and close monitoring. IV steroids were continued, and prophylactic antibiotics were administered. He did well with the treatment and responded rapidly. His O2 levels improved rapidly. The patient was discharged home on oral antibiotics and nebulizer treatments. Home health was arranged to teach the parents how to administer the nebulizer treatments. It was strongly suggested that the grandparents stay at a hotel during their next visit.

Dx: Acute exacerbation—asthma
Probable acute respiratory infection

First-listed diagnosis: ________
Secondary diagnoses: ________
Fill in the blank with correct word.

Answer 1

First-listed diagnosis: ________
Answer: Acute exacerbation of mild persistent asthma – J45.32

Secondary diagnoses: ________
Answer: Probably acute respiratory infection – J22; exposure to secondhand smoke – Z77.22