Article Text
Abstract
A 9-month-old boy presented to the emergency department with acute wheeze. He had a background of cleft lip repair at 4 months and was awaiting palatoplasty. He had mild eczema but had never had a previous wheezy episode, and was awaiting cardiology follow-up for a small patent ductus arteriosus (PDA). He had been at the child minder when symptoms began abruptly with no witnessed event. On assessment, the wheeze had resolved, saturations were 98% breathing air, respiratory rate was 34 breaths per minute and he was afebrile. He was discharged home with safety net advice.
He represented 2 days later with cough, wheeze and shortness of breath. On examination, he had subcostal recession and there was reduced air entry on the right. There was no wheeze, crepitations or obvious organomegaly. Oxygen saturations were 98% breathing air, respiratory rate was 38 breaths per minute and he was afebrile. Oral amoxicillin was given.
Questions
Given the history what is the likely diagnosis?
Bronchiolitis
Congestive heart failure
Foreign body aspiration
Pneumonia
Reactive airways disease
Which investigation would be most useful at this stage?
Bronchoscopy
Chest X-ray
CT chest
Echocardiogram
Point-of-care respiratory strip
What is the next step in the management?
Intravenous ceftriaxone/clarithromycin
Intravenous diuretics
Needle thoracocentesis
Oral steroids and inhaled bronchodilator
Rigid bronchoscopy
What are the long term complications of an undiagnosed foreign body?
Questions Answers can be found on page 2.
- paediatric
- foreign body aspiration
- cough
- wheeze