What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Resolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
reSolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
reSolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Mom brought him in today because of stridor and increased WOB
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Resolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Mom brought him in today because of stridor and increased WOB
Clue 04
The stridor and WOB seemed to improve when they went outside in cold air
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Resolve
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Mom brought him in today because of stridor and increased WOB
Clue 04
The stridor and WOB seemed to improve when they went outside in cold air
Clue 05
On your exam, he has inspiratory stridor at rest with moderate retractions
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Nice!
Dx: Croup (moderate)Tx: Racemic epinephrine and PO, IV, or IM decadron 0.6mg/kg (max 16mg) Note: X-ray above shows steeple sign (subglottic tracheal narrowing)
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
He is UTD on his vaccines
Clue 04
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
He is UTD on his vaccines
Clue 04
On exam he has wheezing and diminished breath sounds on the right
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
resolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
He is UTD on his vaccines
Clue 04
On exam he has wheezing and diminished breath sounds on the right
Clue 05
You give an albuterol treatment but the wheeze and diminished breath sounds do not improve
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
Nice!
Dx: Foreign body aspirationTx: Bronchoscopy for removal Note: Most objects aspirated are radiolucent so don't r/o an aspiration just because there's no foreign body visualized on xray
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
He is completely unimmunized per parental preference
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
He is completely unimmunized per parental preference
Clue 04
From the door you notice the pt is in a tripod position
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
resolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
He is completely unimmunized per parental preference
Clue 04
From the door you notice the pt is in a tripod position
Clue 05
You can hear audible stridor and notice significant retractions. The SpO2 is reading mid 80's.
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
Nice!
Dx: EpiglottitisTx: Critical airway team, intubate (in OR if possible), obtain surgical airway if intubation unsuccessful; empiric abx (eg, CTX and vanc) Note: Red arrow is enlarged epiglottis ("thumb sign"), yellow arrow is thickened aryepiglottic folds
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
She has hives diffusely over her body
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
She has hives diffusely over her body
Clue 04
Patient has a h/o eczema
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
Resolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
She has hives diffusely over her body
Clue 04
Patient has a h/o eczema
Clue 05
You notice from the door that her cuff MAP is 48
Nice!
Dx: Anaphylaxis Tx: IM epinephrine; adjunctive medications/tx (fluid bolus, steroids, H1 and H2 antihistamines, albuterol, racemic epinephrine)
Navigation
Start from beginning
Redo croup case
Redo foreign body aspiration case
Redo epiglottitis case
Redo anaphylaxis case
Stridor
Erica Kim
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Transcript
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Resolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
reSolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
reSolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Mom brought him in today because of stridor and increased WOB
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Resolve
next clue
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Mom brought him in today because of stridor and increased WOB
Clue 04
The stridor and WOB seemed to improve when they went outside in cold air
Clue 05
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Resolve
Clue 01
2 days ago started having rhinorrhea, nasal congestion, poor appetite
Clue 02
Yesterday night spiked fever and started coughing, sounds like a "seal bark"
Clue 03
Mom brought him in today because of stridor and increased WOB
Clue 04
The stridor and WOB seemed to improve when they went outside in cold air
Clue 05
On your exam, he has inspiratory stridor at rest with moderate retractions
What's the dx and tx?
ID: 4 y/o M, vaccinated. Brought to ED for stridor.
Nice!
Dx: Croup (moderate)Tx: Racemic epinephrine and PO, IV, or IM decadron 0.6mg/kg (max 16mg) Note: X-ray above shows steeple sign (subglottic tracheal narrowing)
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
He is UTD on his vaccines
Clue 04
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
He is UTD on his vaccines
Clue 04
On exam he has wheezing and diminished breath sounds on the right
Clue 05
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
resolve
Clue 01
Pt was playing with his toys when dad heard him cough and then develop stridor
Clue 02
He does not have fever, congestion, rhinorrhea
Clue 03
He is UTD on his vaccines
Clue 04
On exam he has wheezing and diminished breath sounds on the right
Clue 05
You give an albuterol treatment but the wheeze and diminished breath sounds do not improve
What's the dx and tx?
ID: 2 y/o M, vaccinated. Brought to ED for stridor.
Nice!
Dx: Foreign body aspirationTx: Bronchoscopy for removal Note: Most objects aspirated are radiolucent so don't r/o an aspiration just because there's no foreign body visualized on xray
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
He is completely unimmunized per parental preference
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
He is completely unimmunized per parental preference
Clue 04
From the door you notice the pt is in a tripod position
Clue 05
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
resolve
Clue 01
Patient spiked fever of 39 this morning. He has been irritable and developed stridor in the last hour
Clue 02
Patient's voice sounded muffled to parents and he has been drooling excessively
Clue 03
He is completely unimmunized per parental preference
Clue 04
From the door you notice the pt is in a tripod position
Clue 05
You can hear audible stridor and notice significant retractions. The SpO2 is reading mid 80's.
What's the dx and tx?
ID: 4 y/o F, unvaccinated. Brought to ED for stridor.
Nice!
Dx: EpiglottitisTx: Critical airway team, intubate (in OR if possible), obtain surgical airway if intubation unsuccessful; empiric abx (eg, CTX and vanc) Note: Red arrow is enlarged epiglottis ("thumb sign"), yellow arrow is thickened aryepiglottic folds
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
reSolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
She has hives diffusely over her body
Clue 04
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
next clue
Resolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
She has hives diffusely over her body
Clue 04
Patient has a h/o eczema
Clue 05
What's the dx and tx?
ID: 4 y/o F, vaccinated. Brought to ED for stridor.
Resolve
Clue 01
Patient developed stridor and dyspnea a few minutes after eating a cookie her neighbor gave him
Clue 02
She complained of abdominal pain and vomited as well
Clue 03
She has hives diffusely over her body
Clue 04
Patient has a h/o eczema
Clue 05
You notice from the door that her cuff MAP is 48
Nice!
Dx: Anaphylaxis Tx: IM epinephrine; adjunctive medications/tx (fluid bolus, steroids, H1 and H2 antihistamines, albuterol, racemic epinephrine)
Navigation
Start from beginning
Redo croup case
Redo foreign body aspiration case
Redo epiglottitis case
Redo anaphylaxis case