Croup and epiglottitis Quiz: Ace Your Exams

A 15-month-old boy is brought to the emergency department by his parent for evaluation of a cough and increased work of breathing. The parent reports the patient has had a “barking” cough for the past two days, and today the patient seemed to be struggling to breathe. He has had low-grade fevers at home and has a sibling with similar symptoms. The patient does not have any significant past medical history and vaccines are up-to-date. Temperature is 37.4°C (99.3°F), pulse is 102/min, blood pressure is 100/60 mmHH, respiratory rate is 32/min, and oxygen saturation is 96% on room air. The patient has stridor at rest, moderate subcostal and intercostal retractions, and an audible barking cough. Based on this infant’s presentation and findings, a diagnosis is made, and he is treated with intramuscular dexamethasone and a single dose of racemic epinephrine. On reassessment 15 minutes later, the patient is resting comfortably in bed with a normal respiratory rate and without stridor. Which of the following is the best next step in management?