A 5-year-old Mexican boy whose vaccination status is unknown is brought to the emergency department with sudden onset of high-grade fever, irritability and difficulty in swallowing. The patient was apparently normal before going to the bed but he awoke in the middle of the night with severe respiratory distress. His temperature is 39.1C(102.4F) and he is in obvious respiratory distress and found to be retracting his intercostals muscles. Saliva is coming out of the corners of his mouth. He feels better when he is sitting erect. What is the most appropriate next step in the management of this patient?
A. Direct visualization of his pharynx by a tongue depressor B. Fiberoptic laryngoscope in the operating room C. Lateral neck film D. Emergency tacheostomy E. Nasotracheal intubation F. Administeration of IV ceftriaxone G. Administeration of racemic epinephrine
I choose E. But the answer is B-fiberoptic laryngoscope. Can any one tell me why it's not E?
fox Forum Guru
Topics: 70 Posts: 727
12/09/06 - 02:59 PM
#2
[left]Blind nasotracheal intubation shuld not be attempted in case of Ac. Epiglottitis. Otherwise this will lead to spasm of the airway with the child crying & that will further compromise the airway. This is also the reason that one shouldnt attempt even an IDL when the child is in discomfort. One should attempt intubation only in the OT with the aid of FOL.[/left] ___________________ Aim High
suny Forum Newbie
Topics: 4 Posts: 5
12/09/06 - 09:57 PM
#3
fox, thanks a lot for the reply. Can you tell me what is IDL?
ed222 Forum Senior
Topics: 4 Posts: 147
12/11/06 - 11:19 AM
#4
thumb sign in s-ray. I think this is the first step
fox Forum Guru
Topics: 70 Posts: 727
12/12/06 - 02:51 AM
#5
suny wrote: fox, thanks a lot for the reply. Can you tell me what is IDL?
