NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationMedium
A 5-year-old child presents with sudden onset of severe respiratory distress, high fever, dysphagia, and drooling. The child is sitting upright, leaning forward with the neck hyperextended (tripod position). Auscultation reveals inspiratory stridor. No cough is present. What is the MOST appropriate initial management step?
- AInitiate bag-valve-mask ventilation if respiratory effort decreases.
- BAdminister humidified oxygen and transport immediately.
- CAttempt to visualize the epiglottis with a laryngoscope.
- DAdminister nebulized racemic epinephrine.
Show answer & explanationAnswer & explanation
Correct answer: B. Administer humidified oxygen and transport immediately.
The patient's presentation is classic for epiglottitis, a life-threatening airway obstruction. The priority is to maintain a patent airway without agitating the child, as this can worsen the obstruction. Humidified oxygen and immediate transport to a facility capable of advanced airway management are crucial.
Why the other options are wrong
- A. BVM ventilation should only be initiated if the child becomes apneic or has inadequate respiratory effort, and great care must be taken to avoid gastric insufflation.
- C. Attempting to visualize the epiglottis can cause laryngospasm and complete airway obstruction in epiglottitis.
- D. Nebulized racemic epinephrine is used for croup, not epiglottitis, and could worsen the child's distress.
Epiglottitis Management
Epiglottitis is a bacterial infection causing inflammation and swelling of the epiglottis, leading to rapid airway obstruction. Management focuses on maintaining a patent airway and minimizing patient agitation.
- Classic presentation: high fever, dysphagia, drooling, tripod position, inspiratory stridor, no cough.
- Avoid anything that could agitate the child (e.g., oral exams, IV attempts, lying supine).
- Provide humidified oxygen and prepare for advanced airway management in a controlled environment.
Memory trick: Don't poke the inflamed pipe, just give it air and GO!