Question

An 18mo child has a 1 week hx of cough and runny nose. The child has diffuse cyanosis and is responsive only to painful stimulation with slow respirations and rapid central pulses. The child's respiratory rate has decreased from 65/min to 10/min, severe inspiratory intercostal retractions are present, heart rate is 160/min, spO2 is 65. What is the most likely diagnosis?

1) Acute bronchiolitis
2) Asthma
3) Pneumonia
4) Foreign body aspiration

Answer 1

The child is likely suffering from foreign body aspiration, indicated by a drastic decrease in respiratory rate, intercostal retractions, and low oxygen saturation, requiring immediate airway assessment and intervention.

Step-by-step explanation:

Considering the symptoms the child is exhibiting, such as diffuse cyanosis, reduced responsiveness, slow respirations, rapid central pulses, severe inspiratory intercostal retractions, a high heart rate, and very low oxygen saturation (spO2), the most likely diagnosis is foreign body aspiration.

The abrupt decrease in respiratory rate from 65/min to 10/min combined with inspiratory intercostal retractions suggests an airway obstruction, which is consistent with foreign body aspiration. In addition, the child is experiencing signs of significant respiratory distress and possible hypoxemia, which can be urgent and life-threatening.

Acute bronchiolitis, asthma, and pneumonia typically present with an increased respiratory rate, not a decreased one like in this case. The immediate action required would be to assess the airway patency and, if necessary, remove the obstruction to restore adequate ventilation and oxygenation to the child.