RT Journal Article
SR Electronic
T1 Cough and you'll miss it
JF Archives of disease in childhood - Education & practice edition
JO Arch Dis Child Educ Pract Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP edpract-2019-318121
DO 10.1136/archdischild-2019-318121
A1 Seana Molloy
A1 Gemma Batchelor
A1 Luke McCadden
A1 Rebecca Moore
A1 Thomas Bourke
A1 Andrew Thompson
YR 2019
UL http://ep.bmj.com/content/early/2021/04/21/archdischild-2019-318121.abstract
AB ­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.QuestionsGiven the history what is the likely diagnosis?BronchiolitisCongestive heart failureForeign body aspirationPneumoniaReactive airways diseaseWhich investigation would be most useful at this stage?BronchoscopyChest X-rayCT chestEchocardiogramPoint-of-care respiratory stripWhat is the next step in the management?Intravenous ceftriaxone/clarithromycinIntravenous diureticsNeedle thoracocentesisOral steroids and inhaled bronchodilatorRigid bronchoscopyWhat are the long term complications of an undiagnosed foreign body?Questions Answers can be found on page 2.