A 5-year-old child is brought to the clinic with a 2-day history of sudden onset of high fever (103°F), difficulty swallowing, drooling, and muffled voice. The child is sitting in a 'tripod position' and appears anxious. The mother reports the child has not been immunized according to the recommended schedule. Which of the following actions should the FNP prioritize?
- APerform a rapid strep test.
- BAdminister intravenous antibiotics and prepare for airway management.
- CObtain a throat culture for bacterial pathogens.
- DOrder a lateral neck X-ray to confirm diagnosis.
Show answer & explanationAnswer & explanation
Correct answer: B. Administer intravenous antibiotics and prepare for airway management.
The child's symptoms (high fever, dysphagia, drooling, muffled voice, tripod position, anxiety, and unimmunized status) are highly suggestive of acute epiglottitis, a life-threatening airway emergency. The priority is to secure the airway, which often requires intubation, and immediately administer intravenous antibiotics to cover Haemophilus influenzae type b (Hib) and other potential pathogens. Diagnostic procedures like X-rays or throat cultures can further compromise the airway and should be avoided or performed only in a controlled environment.
Why the other options are wrong
- A. A rapid strep test is contraindicated due to the risk of airway compromise.
- C. A throat culture can precipitate laryngospasm and airway obstruction in epiglottitis.
- D. A lateral neck X-ray can be helpful but should not delay life-saving interventions and should only be performed if it does not compromise the airway.
Acute Epiglottitis Management
Acute epiglottitis is a medical emergency characterized by inflammation and swelling of the epiglottis, leading to rapid airway obstruction. It requires immediate medical attention, focusing on airway stabilization and antibiotic therapy.
- Often caused by Haemophilus influenzae type b (Hib) in unvaccinated individuals.
- Classic signs include drooling, dysphagia, distress, and a 'tripod position'.
- Airway management is the top priority, often requiring intubation.
Memory trick: Epiglottitis: Emergency! Airway First, Antibiotics Fast!