NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationMedium
A 2-year-old child presents with a 3-day history of low-grade fever, rhinorrhea, and a persistent, harsh, 'seal-bark' cough, primarily at night. Inspiratory stridor is noted when agitated. Respiratory rate is 28 breaths/min, SpO2 is 96% on room air, and lung sounds are clear with occasional transmitted upper airway sounds. What is the most appropriate initial treatment for this patient?
- AAdminister humidified oxygen and consider a single dose of dexamethasone.
- BAdminister nebulized racemic epinephrine.
- CAdminister nebulized albuterol.
- DPrepare for immediate endotracheal intubation due to impending airway obstruction.
Show answer & explanationAnswer & explanation
Correct answer: A. Administer humidified oxygen and consider a single dose of dexamethasone.
This patient's presentation is classic for Croup (laryngotracheobronchitis). The most appropriate initial treatment involves supportive care with humidified oxygen and a corticosteroid like dexamethasone to reduce airway inflammation.
Why the other options are wrong
- B. Nebulized racemic epinephrine is indicated for moderate to severe croup with significant stridor at rest or respiratory distress, which is not present in this mild case.
- C. Albuterol is a bronchodilator and is not effective for the subglottic edema characteristic of croup.
- D. While airway obstruction is a concern in severe croup, this patient's mild symptoms (stridor only when agitated, SpO2 96%) do not warrant immediate intubation.
Croup (Laryngotracheobronchitis)
A common pediatric viral infection causing inflammation and swelling of the larynx, trachea, and bronchi, leading to a characteristic 'seal-bark' cough and inspiratory stridor.
- Caused by parainfluenza virus.
- Symptoms include seal-bark cough, stridor, hoarseness.
- Treatment often involves corticosteroids and humidified air.
Memory trick: Croupy Cough, Cool Air Comforts Kids.