2-year-old boy with cough and difficulty breathing is brought to the emergency department by his mother

2-year-old boy with cough and difficulty breathing is brought to the emergency department by his mother. She says that he was well and playing with his toys until 2 hours prior to presentation. He is healthy, but his 6- year old brother has a peanut allergy The patient’s temperature is 36.7 C (98 F), blood pressure is 92/48 mm Hg, pulse is 114/min, and respirations are 48/min. The patient’s pulse oximetry shows 91 % on room air. Physical examination shows nasal flari ng and grunting with both subcostal and intercostal retractions. Wheezing is heard in the right lung field; the left field is clear to auscultation. No rales or rhonchi are noted. The remainder of the physical examination is within normal limits. Supplementary oxygen is applied Chest x-ray reveals mild hyperinflation of the right lung. Which of the following is the most appropriate next step in management of this child?

  • QA Bronchoscopy
  • 0 B. Chest computed tomography scan
  • 0 C. Chest physiotherapy
  • 0 D. Chest tube placement
  • 0 E. Intramuscular epinephri ne
  • 0 F Nebulized albuterol
  • 0 G. Racemic epinephrine

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