Pneumonia (pediatrics) Quiz: Ace Your Exams
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A 5-month-old boy is brought to the emergency department by his parents for evaluation of a cough that has been present for 7 days. The patient was diagnosed with viral bronchiolitis on day 2 of illness and tested positive for respiratory syncytial virus (RSV). Since that diagnosis, the patient had initial improvement of symptoms and resolution of fever. Then, on day 5 of illness, he developed a worsening cough with wheezing, and that morning had a fever of 102 °F. The patient has a history of wheezing with respiratory infections. He has been drinking and making urine. The patient is not fully vaccinated. His mother has a history of asthma. Temperature is 38.4°C (101°F), blood pressure is 97/67mmHg, pulse is 137/min, respiratory rate is 35/min, and oxygen saturation is 92% on room air. The patient appears comfortable without signs of respiratory distress. Skin exam shows good skin turgor. Cardiopulmonary examination reveals crackles in the left lower lobe. Chest X-ray shows a left lower lobe infiltrate. Which of the following is an indication of hospitalization in this patient?
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