390.A 5-month-old boy, ex-34 week preemie, is brought to the ED by his
mother who reports that the infant has been breathing with extra effort for
the last 2 days. He has no other past medical history and is current on
immunizations having received the full course of vaccines at both 2 and
4 months. The mom reports the child has had rhinorrhea and a cough.
Upon physical examination, the patient has a temperature of 101.1°F, H R
160 beats per minute, RR 70 breaths per minute, pulse oximetry of 87% on
room air. The infant has copious nasal discharge, audible wheezing with
diffuse rhonchi and rales upon chest auscultation. He also has intercostal
retractions and nasal flaring. A chest radiograph shows increased perihilar
markings, hyperinflation and diffuse patchy areas of atelectasis versus infil-
trates. Given this patient’s history and physical examination, which of the
following is the most likely etiology of his symptoms?
a. Foreign body aspiration
b. Asthma
c. Pneumococcal pneumonia
d. Respiratory syncytial virus (RSV)
e. Parvovirus B19
391.A 4-year-old girl is brought to the ED after a falling from a tree. She
hit her head on the ground and has significant temporal swelling on the left
side. In transit to the hospital by her parents, the patient had multiple
episodes of emesis. On arrival to the ED, the patient is confused and agi-
tated and then becomes acutely unresponsive and apneic. You make the
decision to endotracheally intubate the patient. Which of the following is
the most appropriate endotracheal tube (ETT) to use in this intubation?
a. 4.0 uncuffed ETT
b. 4.0 cuffed ETT
c. 5.0 cuffed ETT
d. 5.5 uncuffed ETT
e. 4.5 uncuffed ETT
412 Emergency Medicine