A 6-year-old child presents with a sudden onset of high fever (103.5°F/39.7°C), severe sore throat, difficulty swallowing, and drooling. The child is sitting upright, leaning forward with an extended neck (tripod position), and has inspiratory stridor. Which of the following is the most appropriate initial intervention?
- AAllow the child to maintain a position of comfort and provide supplemental oxygen.
- BAdminister nebulized racemic epinephrine.
- CInitiate IV access and administer a fluid bolus.
- DAttempt to visualize the pharynx with a tongue depressor.
Show answer & explanationAnswer & explanation
Correct answer: A. Allow the child to maintain a position of comfort and provide supplemental oxygen.
The child's presentation (high fever, severe sore throat, drooling, difficulty swallowing, tripod position, and stridor) is classic for epiglottitis. The priority is to maintain the airway without aggravating it. Any attempt to visualize the pharynx can cause laryngospasm and complete airway obstruction. Allowing a position of comfort and providing supplemental oxygen are the safest immediate interventions.
Why the other options are wrong
- B. Nebulized racemic epinephrine is primarily used for croup, which has a different etiology and presentation (barking cough). It is not indicated for epiglottitis.
- C. While IV access may be needed later, it is not the immediate priority over airway management and can distress the child, potentially worsening airway compromise.
- D. Attempting to visualize the pharynx can induce laryngospasm and complete airway obstruction in epiglottitis.
Epiglottitis Management
A life-threatening inflammation of the epiglottis, typically bacterial, causing rapid airway obstruction. Characterized by sudden high fever, sore throat, drooling, and tripod positioning.
- Do NOT attempt to visualize the pharynx or lay the child supine.
- Maintain position of comfort and provide oxygen.
- Rapid transport to a facility with airway management expertise is crucial.
Memory trick: Epiglottitis: Every Patient Gets Immediate Gentle Airway Care.