Croup and epiglottitis Quiz: Ace Your Exams

A 7-year-old boy is brought to the emergency department by EMS after his parent called them because the patient appeared to be struggling to breathe with very noisy breathing. His parent reports that over the past 24 hours, the patient rapidly developed a high fever and a “raspy” voice. He has not been coughing. The patient was born full-term and does not have a significant past medical history; however, his vaccines are not up-to-date. Temperature is 39°C (102.2°F), pulse is 144/min, blood pressure is 91/60 mmHg, respiratory rate is 45/min, and oxygen saturation is 93% on room air. The boy appears anxious with difficulty breathing. He is hunched forward on the gurney with his neck extended with audible stridor and drooling. Examination of the throat reveals erythema of the posterior pharynx and cervical lymphadenopathy. Which of the following is the best next step in management?