Question

Case 18: 16-month-old M brought to the ED by his mother because of a progressive barking cough and noisy breathing over the past 10 hours. Sx's preceded by a runny nose that began 2 days ago, and he seems to have a sore throat. Vaccinations are up to date, he has not ingested any foreign objects, and his appetite is good. Vital signs on presentation reveal a low-grade fever and are otherwise normal.

1. Emergency orders
2. Physical Exam
3. Diagnostic tests
4. Therapy
5. Location
6. Final order
7. Dx

Answer 1

A 16-month-old child with a progressive barking cough and noisy breathing is likely experiencing croup, which is a common respiratory infection at this age. Important steps include assessment, monitoring, supportive care, and possibly corticosteroid therapy, with a focus on ensuring a patent airway and adequate breathing.

Step-by-step explanation:

The case described suggests a 16-month-old child with symptoms indicative of a respiratory infection, likely croup, which is often characterized by a barking cough, stridor, and may be associated with symptoms such as a runny nose and sore throat. Emergency orders should prioritize airway assessment and support. A physical exam is key, with particular attention to the respiratory assessment—listening for stridor, observing for retractions, and examining for signs of respiratory distress. Diagnostic tests may include pulse oximetry, and possibly a neck X-ray to rule out other causes of stridor. Therapy usually involves supportive care, including humidified oxygen if necessary, and possibly a dose of a corticosteroid to reduce airway inflammation. The patient should be located in an area where they can be closely monitored for any signs of worsening. The final order would include patient disposition—either discharge home with parental education and follow-up instructions or admission for observation and further treatment depending on the severity of symptoms. The likely diagnosis for this case is croup.