Parker, a 3-Year-Old Boy with Difficulty Breathing

Abstract

CASE PRESENTATION While on an overnight shift, you are called by the emergency department (ED) physician with a request to evaluate a new patient for admission. The ED physician tells you about Parker, a 3-year-old boy who presented tonight with difficulty breathing. Parker is healthy despite being born at 31 weeks’ gestation. He has had coughing and rhinitis for 2 days and a fever up to 38.2 °C (100.8 °F). Tonight, he was breathing louder and harder, so his parents brought him to the ED. He had significant respiratory distress in the ED, where he was given oral dexamethasone and a nebulized racemic epinephrine treatment with subsequent improvement. While he was being monitored in the ED, his symptoms returned 2 hours later, and he was treated again with racemic epinephrine. The ED physician is requesting admission for continued monitoring.