393.A 2-year-old girl is brought into the ED with 2 days of fever and
runny nose. Today she developed a dry, harsh, “barking” cough. Her tem-
perature is 103.3°F, HR 123 beats per minute, RR 25 breaths per minute,
and pulse oximetry of 98% on room air. On evaluation you note an alert,
responsive but somewhat anxious female, in moderate respiratory distress
with stridor and suprasternal retractions at rest. She has nasal congestion,
equalair entry bilaterally with no rales or wheezes and a normal ear and
throat examination. After receiving a single treatment of racemic epinephrine,
she feels better and her work of breathing improves. Which of the following
is the most appropriate next step in management?
a. Chest radiograph
b. CBC and blood culture
c. Soft tissue radiograph of the neck
d. Administer broad-spectrum antibiotics
e. Administer a dose of steroids
414 Emergency Medicine