Pediatric Emergency Medicine

Case Study of the Month - February

Mohsen Saidinejad, MD, MBA
Children’s National Medical Center

A 4-year-old female is brought to the ED with a complaint of noisy breathing. The patient had been in her usual state of health except for a mild upper respiratory infection, fever, and cough for the past two days.  Over the previous hour, the patient was noted to have worsening cough.  Her 9-year-old sister reports that the patient began having trouble catching her breath and was drooling and choking.  Patient was brought to the ED by car, and during the short drive, the patient seemed to stop coughing. In the ED, the patient appears to be anxious. Her vital signs are as follows:  T 37.2ºC,  HR 122,  RR 28, BP 108/71, and pulse oximetry on room air is 98%.  On examination, the patient is slightly tachypnic and has audible stridor at rest.  No wheezes or crackles are heard.  Her pulses are equal and strong bilaterally. You decide to obtain a soft tissue neck x-ray, which is shown here. 

Peds Case Study Feb 13 - Thumb

 What is the next step in the management of this patient?

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