Question

2 yo girl is alert with mild breathing difficulty during inspiration and pale skin. She has mild stridor when agitated, otherwise breathing is quiet. 92% O2 on RA, mild inspiratory intercostal retractions. Auscultation reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which is the most appropriate inital intervention?

A. IV dex
C. Nebulized albuterol
C. humidified oxygen as tolerated
D. endotracheal intubation

Answer 1

The most appropriate initial intervention for a 2-year-old with mild breathing difficulty and stridor is humidified oxygen as tolerated, to increase blood oxygen levels and soothe the airways without over-intervention.

Step-by-step explanation:

In the clinical case of a 2-year-old girl presenting with mild breathing difficulty during inspiration, pale skin, mild stridor when agitated, and oxygen saturation of 92% on room air, the most appropriate initial intervention would be C. humidified oxygen as tolerated. This intervention provides supplemental oxygen to increase blood oxygen levels while the humidity can help soothe the inflamed airways. Since the child has adequate distal breath sounds and only mild intercostal retractions, more aggressive interventions such as endotracheal intubation or nebulized albuterol are not indicated at this time. IV dexamethasone (dex) could be considered for anti-inflammatory effects, but it's not the first line of treatment for this presentation. The goal is to increase oxygen saturation and provide relief from respiratory distress without causing additional stress or discomfort.