In the ED, their vitals/exam are as above. I am concerned for imminent airway compromise due to *** given patient’s past medical history and {Airway Signs & Symptoms:43078}. *** concern for active bacterial infection given patient is ***febrile. Given this, will proceed as below
– Labs/Tests: VBG plus, Lactate, CBC, CMP, PT/INR, T&S. Consider procalcitonin, blood cultures, COVID swab, flu swab, UA w/ reflex UCx.
– Imaging: CXR, Consider CT neck w/ & w/o IV contrast
– Treatments:
— Escalating respiratory support as indicated: NC -> NRB -> HFNC -> Intubation (VL vs. awake fiberoptic intubation)
— If no evidence of anaphylaxis/asthma exacerbation: Racepinephrine 2.25% (0.5mL vial + 2.5-4.5mL of sterle 0.9% NaCl to dilute) nebulization q15-20mins, Dexamethasone 0.6mg/kg IV (maximum 10mg) x1
— If evidence of anaphylaxis: Epi 0.3mg IM q5 minutes (until Epi drip is ready) -> Epi drip, Dexamethasone 0.6mg/kg IV (maximum 10mg) x1, Benadryl 50mg IV x1, Famotidine 40mg IV x1
— If evidence of asthma exacerbation: Continuous Duonebs, Epi 0.3mg IM q5 minutes (until Epi drip is ready) -> Epi drip, Dexamethasone 0.6mg/kg IV (maximum 10mg) x1, Magnesium sulfate 4g IV x1, Terbutaline 0.25mg SQ x1
— Low threshold for broad spectrum antibiotics
— IVF/Pain control/Antiemetics as needed
– Consults: ***. Consider anesthesia/ENT/surgery at bedside for airway assistance
– Dispo: Likely admission to ICU