Check out today’s Step 2 CK Qmax Question Challenge.
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A 3-year-old boy presents to the emergency department (ED) with a fever and difficulty breathing. He is the product of a normal pregnancy and has been healthy since birth. His immunizations are up to date. This morning he appeared to be in his usual state of health and was dropped off at day care by his father. Later on, his teacher noticed that he had suddenly become fussy and flushed and could not be consoled with toys, rocking, or hearing a story. He also felt warm to the touch and was drooling more than usual. When she took his temperature, it was 39°C (102.2°F). His parents were contacted immediately, and the patient was brought to the ED. He appears toxic and anxious, and has loud labored breathing. He is sitting upright, bracing himself on his arms, with his neck hyperextended and mouth open. His temperature is 40°C (104°F), respiratory rate is 50/min, pulse is 140/min, blood pressure is 102/62 mm Hg, and oxygen saturation is 100% on room air. Lateral x-ray of the neck is shown in the image. Laryngoscopy reveals a large cherry-red epiglottitis.
What is the most appropriate next step in management?
A. Antibiotic therapy
B. Corticosteroids
C. Nasotracheal intubation
D. Observation
E. Tracheostomy
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C
C.
B
c
C
C The patient has epiglottitis