Ped. q -

[ArchivalUser]

mnhakeem

A 6-month-old boy presents to the Emergency Department with a three-day history of cough, congestion and low grade fever. The mother states that the baby has not been feeding well and has used only two diapers over the past 24 hours. Physical examination reveals a pale infant with a temperature of 37.8 C (100.1 F), pulse of 170/min, respirations of 60/min and oxygen saturation of 88% on room air. The patient exhibits nasal flaring, subcostal and intercostal retractions.Lung examination reveals diffuse wheezing. Cardiac examination reveals a regular but tachycardic rhythm with no murmur. Central capillary refill is four seconds. The remainder of the examination is normal. Which of the following is the most appropriate initial step in management?
A. Chest x-ray film
B. Albuterol nebulizer treatment
C. Bolus of intravenous fluids
D. Oxygen therapy
E. Intravenous steroids

[ArchivalUser]

mk

a?

[ArchivalUser]

JC

I would put O2 treatment, becaus eof his low saturation y resp difficulty. But I'm very curious of what others say.

[ArchivalUser]

Nasi

I think first we should dio something with his respiratory failure ,then I am going with D!

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DM

It sounds like bronchiolitis, i'd go for D: oxygen therapy first, then do a CXR.

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mk

yes i also thought bronchiolitis but don't you think the next step is x-ray

[ArchivalUser]

sunlight

D. Oxygen therapy

[ArchivalUser]

joeey

C: cappilary refill is 4 secs that is too long that shows the baby is dehydrated so give Fluids that is the first thing i would pick

[ArchivalUser]

Lou - lmcgyver@earthlink.net

If its bronchiolitis then give nebulizer first, with O2 as needed. Supplement with fluids as well.

[ArchivalUser]

mnhakeem

thanks guys the correct Answer is D
Always remember your ABCs. this patient is hypoxic and needs oxygen to help decrease his work of breathing. A chest x-ray film (choice A) is certainly indicated, but not a priority. Albuterol nebulizer treatments (choice B) are indicated as an initial trial. If benefits are seen, they can be continued. Some studies have shown racemic epinephrine to be more effective than albuterol in viral respiratory infections. They too should follow initial oxygen therapy. Delayed capillary refill is an indication for a bolus of IV fluid (choice C). This however, is the C in ABCs