Rosh Pediatrics Practice Exam

What is the best next step for a child with suspected epiglottitis showing difficulty breathing?

1. Defer further agitation and perform endotracheal intubation

2. Establish intravenous access for antibiotic therapy

3. Order a laryngoscopy

4. Order a lateral neck radiograph

The correct answer is: Defer further agitation and perform endotracheal intubation

In a situation where a child is suspected to have epiglottitis and is exhibiting difficulty breathing, the priority is to ensure the airway is secure. Immediate intervention is crucial because epiglottitis can lead to rapid airway obstruction. Performing endotracheal intubation is often necessary in such cases to ensure that the child can breathe properly and prevent asphyxiation. This procedure should be done gently and carefully, minimizing any additional agitation that could exacerbate the airway obstruction. Intubation allows for controlled ventilation and further evaluation of the airway. The other options do not prioritize airway management effectively. For example, establishing intravenous access for antibiotic therapy is important but does not address the immediate threat to the airway. Ordering a laryngoscopy could potentially worsen obstruction, and a lateral neck radiograph might delay necessary intervention, putting the child at greater risk. Therefore, securing the airway through endotracheal intubation is the best next step.