A 3-year-old presents with high fever, stridor, and drooling. The child sits leaning forward with the jaw thrust out, refuses to lie down, and has a muffled hot-potato voice. The resident wants to perform a tongue depressor examination of the throat. What is the correct immediate management priority?

• A Perform throat examination immediately to confirm the diagnosis before treatment
• B Secure the airway in the operating theatre with an experienced team, avoiding supine positioning and throat instrumentation ✓
• C Give nebulized budesonide and observe for 24 hours
• D Obtain a lateral neck radiograph in the supine position before any intervention

Explanation

The tripod posture, drooling, muffled voice, and high fever indicate acute epiglottitis, usually due to Haemophilus influenzae type b. Any instrumentation of the throat or forced supine positioning can trigger complete airway obstruction and death. The priority is transfer to theatre for inhalational induction and intubation with a surgeon and anaesthetist prepared, followed by blood cultures and antibiotics such as ceftriaxone. Radiography and throat examination delay definitive airway control.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.