Question

Girl, 2 years old. At the reception of the pediatrician with complaints about: stuffy nose, runny nose, rare dry cough, body temperature 37,6oC. From the anamnesis: sick for 4 days, acutely ill, after attending kindergarten in the evening the body temperature rose to 37.8 оС. Breathing through the nose became difficult, there were mucous discharge from the nose. For 3 days dry cough, shortness of breath. The baby was restless, had a single vomiting. Earlier, I was ill. Moderate manifestations of atopic dermatitis at 1 year of life associated with the introduction of supplementation. Family history is not burdensome. On examination: the condition of the baby is severe. The skin is pale, cyanosis of the nasolabial triangle, the ears, the tips of the fingers. Breathing noisy, superficial, with difficulty in exhalation and participation in the act of breathing of the auxiliary muscles (nose wings, shoulder girdle), intercostal involvement, hours to 80 in 1 min. Chest is swollen, above the lungs - a boxy tinge of percussion sound, with auscultation breathing is hard, the exhalation is sharply elongated, small-bubbling dry wheezing wheezes all over the lungs surface. Heart sounds are loud, heart rate is 172 in 1 min. Other organs and systems at physical examination - without features. The child is hospitalized. At the hospital examination: SaO2 88%, blood test: HB 140 g / l, RBC 4,3x1012; WBC 8,4x109 / l; ESR 15mm / h; e3%, g 1%, s 57%, l 33%, m 6%. Chest X-ray - There is a sharp swelling of the tips. Diffusely enhanced pulmonary pattern, strengthened and low spaced roots. Aperture domes are clear. The middle shadow is usually located.

Answer 1

A 2-year-old girl, acutely ill for 4 days with stuffy nose, cough, and breathing difficulties. Severe condition, hospitalization with cyanosis, wheezing, elevated heart rate, and abnormal X-ray findings.

The 2-year-old girl presents with a 4-day history of severe illness characterized by a stuffy nose, runny nose, rare dry cough, and a body temperature of 37.6oC.

Following her attendance at kindergarten, her condition worsened, marked by increased body temperature (37.8oC), difficulty breathing through the nose, mucous nasal discharge, and a persistent dry cough with shortness of breath.

The child is restless and experienced a single episode of vomiting.

The mother reports a history of atopic dermatitis at 1 year, linked to supplementation.

On examination, the child appears severely ill, with pale skin, cyanosis of the nasolabial triangle, ears, and fingertips.

Breathing is noisy, shallow, with difficulty in exhalation, involving auxiliary muscles, and the chest shows signs of respiratory distress.

Auscultation reveals hard breathing with sharply elongated exhalation and small-bubbling dry wheezing wheezes throughout the lung surface.

The heart rate is elevated at 172 beats per minute. SaO2 is 88%. Blood tests indicate elevated hemoglobin, normal red blood cell count, slightly elevated white blood cell count, and an elevated ESR.

Chest X-ray shows sharp swelling of the tips, diffusely enhanced pulmonary pattern, and clear aperture domes. The middle shadow is appropriately located.

The child is hospitalized for further evaluation and management.