5. A 3-old child is brought to the pediatric emergency with complains of cough, sputum and shortness of breath. The child is said to refuse food after a few mouthful and splutters and cough. The child is dyspnoeic. Chest examination shows reduced air entry in the right lung with prolonged expiration. The doctor is worried because she was admitted to the pediatric ward thrice in 2 months. Chest X-ray shows prominent bronchial markings on both sides with hyperinflation on the left side. Learning Hints: 1. Which primary physician should you refer the patient to? 2. What are the clinical issues here? 3. Explain the repeated presentations to the hospital. 4. Could there be a relationship of his respiratory symptoms with that of his refusal to eat? 5. Suggest further investigations and justify your answer. 6. What management plan would you suggest for this child? 7. How would you counsel the parents about your management plan?
this seems like a foreign body aspiration into the rt mainstem bronchus. the hyperinflation on the left side is compensatory. while eating or drinking the patient decompensates further as the epiglottis closes over the laryngeal inlet. the repeated presentations could be becos of foreign body reaction, pneumonitis or bronchiectasis and abscess. urgent x ray or directly go for rigid bronchoscopy ( since the physical exam is so suggestive ) send the child to either a chest physician or an ENT doc or to the EM dept. , whichever is feasible. counselling the parents...don't bother ( no use )
