You are a respiratory therapist covering the emergency room in a rural hospital. AT 1430 you get called to assess an 8 month old girl. The parents were driving her home after a birthday party when she started making high-pitched breathing noises from the backseat.

You are a respiratory therapist covering the emergency room in a rural hospital.  AT 1430 you get called to assess an 8 month old girl.  The parents were driving her home after a birthday party when she started making high-pitched breathing noises from the backseat.

What should you do?(explain in detail)

Parents state she has no known allergies and recently started eating finger foods.   They just finished eating at the party when she started to get fussy.  It was her naptime so the family placed her in the car and left.  On the drive she starting cooing and babbling for a while but then started whining, then crying and then making high-pitched squeaking noises.  The parents state she was a healthy baby with no prior respiratory issues.

What do you do know? (Explain in detail)

The girl is a cubby infant sitting uncomfortably in her father’s arms.  She is kicking her legs and grimacing and doesn’t seem to be able to settle.  You can hear what sounds like a loud inspiratory “wheeze” similar to stridor.  She occasionally lets out a weak cry.  Her cheeks are flushed pink and her skin is warm to the touch.  Heart rate is 180bpm, respiratory rate is 70 breaths/min and sat is 90%.  Blood pressure is 60/33.  When you auscultate you notice a wheezing noise during inspiration and the baby closes her eyes and relaxes her grimaced face.

What do you do know? (Explain in detail)

The baby is now less active and no longer crying.  She is less alert than a few minutes ago.  Her respirations are now 25 breaths/min.

What do you do know? (Explain in detail)

It is estimated that the baby’s weight is 8 to 9 kg.   Her respiratory rate is now 6 breaths/minute.

What do you do now? (Explain in detail)

What do you think is wrong with the baby?

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