I have recently heard the quote, “the eyes do not see what the mind does not know” & feel it is incredibly applicable to this particular case, which some of you may have seen recently in one of my Tweets.

A 10 year old Samoan presents to our ED with ‘asthma.’ She is febrile (39.4*C), tachycardic at 124 / min (sinus), with a systolic BP of 124 mmHg & has room air saturations of 93%. She is wheezy, no doubt about it; and has a prolonged expiratory phase with pursed lip breathing. However, she is also clammy and pale. Her grandfather reports this is the first time she has had “asthma”, let alone any other respiratory illness. He also mentions that the GP has been treating her for “gout” over the past 1-2 years.

I am asked to review her at 5am as her salbutamol therapy does not appear to be helping. My routine is to xray all ‘first time wheezers’ especially if the story is a little odd. This is hers…

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