Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Supraglottic Airway Devices for Pediatric Airway Management in the ED right.
Case Presentation: Management of Pediatric Head and Neck Infections in the Emergency Department
A previously healthy 2-year-old girl is brought to the ED by her mother for noisy breathing and limited neck movement. The patient had fever to 39°C (102.2°F) for 2 days and a week of rhinorrhea prior to the onset of fever. The mother says the girl has been drooling for the past day. The girl’s physical examination is notable for an anxious-appearing toddler with a temperature of 39°C, heart rate of 195 beats/min, blood pressure of 90/60 mm Hg, respiratory rate of 60 breaths/min, and oxygen saturation of 89%. You note stridor at rest, with supraclavicular and subcostal retractions. The girl refuses to look toward her right side.
You put the child on a nonrebreather and prepare for intubation. Given the child’s symptoms, you are highly concerned that she may have an infectious process causing significant airway obstruction. With this concern, you have some trepidation in managing her airway and start to consider who to call in order to prevent any further complications, and which airway adjuncts to use when managing this difficult airway…
Case Conclusion
The 2-year-old girl was promptly diagnosed with a retro-pharyngeal abscess. The child was kept calm and her vital signs were monitored closely prior to being taken to the OR for management by otolaryngology. The girl’s airway was secured, and she underwent incision and drainage of the abscess. After a day of observation in the PICU, she was transitioned to the floor. Her operating room cultures grew group A Streptococcus pyogenes, and she was started on IV ampicillin-sulbactam based on sensitivities, and she did well. Once she became afebrile and was able to tolerate oral intake, she was transitioned to oral amoxicillin-clavulanate and sent home, without any complications.
Last Updated on January 26, 2023
paralyze and ventilate – fluid resuscitation and antibiotics – consider LP if your call to the peds ICU provides the usual – we can’t take her now – check urine just to be safe via Cath since she’s paralyzed and monitor for changes till transfer
get the BC’s before the antibiotics – LOL