Pediatrics 411388.A 4-year-old boy is brought to the ED by his parents who state that
he is having difficulty breathing. The patient has a 1-week history of fever,
congestion, and cough. Over the last 2 days the patient was tired-appearing
with intermittent vomiting and persistently increased RR despite adminis-
tration of acetaminophen. On presentation, his vital signs are temperature
100.5°F, HR 185 beats per minute, RR 50 breaths per minute, BP 75/40 mm Hg,
and pulse oxymetry of 88% on room air. He is ill-appearing and listless. He
has diffuse rales noted on auscultation, pulses are weak and thready, and
his liver is palpable 3 to 4 cm below the right costal margin. After several
attempts at a peripheral IV, the patient becomes increasingly somnolent.
Which of the following is the most appropriate method of obtaining access
in this patient?
a. Internal jugular central line
b. Femoral vein central line
c. Saphenous vein cutdown
d. Large-bore IV in antecubital fossa
e. Intraosseous needle
389.A 3-year-old girl is brought to the ED with acute onset of respiratory
distress. She recently emigrated from Africa. Her initial vitals include HR of
115 beats per minute, BP of 110/60 mm Hg, and RR of 28 breaths per
minute with oxygen saturation of 88% on room air. She is also febrile to
103.5°F. She is ill- and anxious-appearing, sitting forward in her mother’s
lap, and drooling. Her mother tells you that she had a sore throat that
began 2 days prior and that she was going to see her pediatrician this week
for her initial vaccinations. Given this patient’s history and presentation,
which of the following should be of particular concern?
a. Epiglottitis
b. Retropharyngeal abscess
c. Epstein-Barr virus
d. Ludwig’s angina
e. Peritonsillar abscess