Pediatric Problem Solving-Case20

Pediatric Problem Solving – Case 20
A 2 month old boy with a 3 day history of mild fever and runny nose suddenly develops high fever, cough and respiratory distress. Within 48 hours, the patient deteriorated and has developed a peumatocele and a left sided pneumothorax.
What is the most appropriate first action?
A.I.V. antibiotics

B.Blood gases

C.Chest tube

D.Antipyretics

Explanation of the case:
mild fever and runny nose = common cold
Suddenly develops high fever, cough and respiratory distress indicates that common cold progress to lower respiratory tract infection, then pneumonia.
The patient develops pneumothorax which is very dangerous as it compresses the lung and may lead to cyanosis and shock.
1st action to be done is to treat pneumothorax
 Choice (A) : point against: it takes 48 hs to start action and this case is emergency
 Choice (B): point against: it diagnoses acidosis, but this is not the 1st action.
 Choice (C): point with: chest tube is needed to drain air and must be done immediately.
 Choice (D): point against: part of the ttt but not the 1st action.