NREMT Paramedic Cognitive ExamMedicalMedium
A 6-year-old child presents with a sudden onset of high fever (103.5°F/39.7°C), severe sore throat, drooling, and inspiratory stridor. The child is sitting in a 'tripod' position and appears anxious. Auscultation reveals diminished breath sounds bilaterally. Which of the following is the most appropriate initial intervention?
- APrepare for immediate nasogastric tube insertion.
- BAttempt to visualize the airway with a tongue depressor.
- CAdminister oral antibiotics immediately.
- DMaintain a position of comfort and provide supplemental oxygen.
Show answer & explanationAnswer & explanation
Correct answer: D. Maintain a position of comfort and provide supplemental oxygen.
The child's symptoms (high fever, severe sore throat, drooling, stridor, tripod position, anxiety) are classic for epiglottitis. The priority in managing epiglottitis is to avoid agitating the child, which can precipitate complete airway obstruction. Maintaining a position of comfort and providing supplemental oxygen are crucial initial steps while preparing for advanced airway management in a controlled environment.
Why the other options are wrong
- A. Nasogastric tube insertion is not indicated for epiglottitis and carries a risk of further airway irritation.
- B. Attempting to visualize the airway with a tongue depressor can provoke laryngospasm and complete airway obstruction in epiglottitis, making it a dangerous intervention.
- C. Oral antibiotics are a treatment for infection, but not an immediate life-saving intervention for acute airway obstruction.
Epiglottitis Management
Emergency care for inflammation of the epiglottis, a life-threatening condition causing airway obstruction, characterized by avoiding airway manipulation.
- Do NOT attempt to visualize the airway (tongue depressor)
- Maintain position of comfort, minimize agitation
- Provide supplemental oxygen, prepare for advanced airway management
Memory trick: Silent Child, Open Airway, Oxygen Flow: Epiglottitis Protocol!