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A 10 year old male was admitted to the floor for hypoxia. He has had a cough for 2 weeks and a fever for 2 days. Tmax 40C. He started with cough and congestion, was seen by PCP and diagnosed with a viral URI. He seemed to improve after a week but then the symptoms came back. The cough is worse and now he has a high fever. He has decreased PO intake and decreased urine output. CXR in the ED revealed a right pleural effusion. In the ED he required 2L of nasal canula of hypoxia. On arrival to the floor, he has worsened and now has increased work of breathing and oxygen saturation of 90% while on 5L nasal canula. On exam, there are no audible breath sounds on the right.

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Recognize Cues

-10 y/o male

-hypoxemia

-fever for 2 weeks

-cough for 2 weeks

-R pleural effusion

-*No audible breath sounds on the right*

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-Increased work of breathing and oxygen saturation of 90% on 5L nasal cannula.

-No audible breath sounds on the right side, and the chest x-ray showed right pleural effusion.

-Consider: Right lung may have collapsed.

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A collapsed right lung is highly likely as evidenced by absent breath sounds on the right side, increased work of breathing, and an increased need for oxygen from 2 liters to 5 liters.

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-Needle aspiration, where a doctor inserts a needle into the chest wall to pull air out, relieve discomfort, and improve breathing.

- If the issue is not resolved surgery may be necessary and a chest tube will be placed to remove the excess air.

-Continued observation and pain management with pain medications.

-Increased oxygenation when appropriate.

-Continuous pulse oximetry.

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-NPO status in case of surgery.

-Anticipate orders for pain management.

-Respiratory support measures including increasing oxygenation and continuous monitoring pulse oximetry.

-Lab work: Chest x-ray, ABG, and a blood cultures test.

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Mackenzie Adams