Croup and epiglottitis Quiz: Ace Your Exams
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A 2-year-old girl is brought to the emergency department by her parent for a “barking” cough and nasal congestion for the past 3 days. Today her parent noticed she was having difficulty breathing. She was diagnosed with respiratory syncytial virus (RSV), 3 days ago by her pediatrician when her symptoms started. She was born at 33 weeks gestation and was briefly hospitalized in the neonatal intensive care unit (NICU), but otherwise has no significant past medical history. Vaccines are up-to-date. Temperature is 37.4°C (99.3°F), pulse is 102/min, blood pressure is 107/60 mmHg, respiratory rate is 30/min, and oxygen saturation is 96% on room air with good air entry. The patient is awake and alert and has stridor at rest with moderate subcostal and intercostal retractions. Oral examination reveals erythematous changes of the posterior pharynx with moist mucous membranes. Based on these findings, the patient is given intramuscular dexamethasone. Which of the following clinical features is an indication for treatment with nebulized racemic epinephrine?
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