Your patient is a five-year-old female who awoke with a harsh cough, sore throat, drooling, and high fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing, leaning forward on her outstretched arms. Which of the following is the best course of action?
A) Start an IV for administration of succinylcholine and midazolam for RSI, intubate the trachea, and ventilate at a rate of 24 to 28 per minute.
B) Provide high-concentration oxygen by nonrebreather mask, start an IV and repeat a full set of vital signs every 5 minutes en route to the emergency department.
C) Inspect the hypopharynx for edema and be prepared for immediate surgical cricothyrotomy if airway obstruction is imminent.
D) Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her.
Question 2
You have been called for a 4-year-old female who is short of breath. Her mother informs you that she has had a fever and runny nose for two days and today began to have difficulty breathing. Furthermore, she is having a difficult time waking her up. Your assessment reveals her to be responsive to painful stimuli and breathing at 12 times a minute with minimal chest and abdominal rise and fall. Her skin is warm to the touch with cyanosis around the lips. Your partner informs you that her heart rate is 124 beats per minute. You find the girl lying in bed with snoring respirations despite use of the head tilt,-chin lift airway maneuver. Your immediate action in caring for this child next is:
A) positive pressure ventilation.
B) suctioning the airway.
C) application of a nonrebreather face mask and oxygen.
D) insertion of a nasal airway.