Pediatric Emergency


Satyam is 11 months old male child who had been brought to me by his parents with complaints of cough for 15 days,breathlessness for 12 days which has markedly increased in last 4 days and refusal to feed for last 24 hours.Fever was present at the onset of illness with running nose and persisted for 2-3days,then there was no fever.Threre was no history of vomiting or noisy breathing.He had been treated by 2-3 Pediatricians at different locations of India at different times with no response.He had been nebulized with different medications,given oxygen by mask,intravenous fluids and injectable antibiotics by different pediatricians.There was no contact with adult pulmonary tuberculosis and no history of asthma or allergy in family.When I exanined the child,there was tachypnea,tachycardia with marked suprasternal,intercostal and subcostal retractions with flaring of ala nasi.SPo2 on room air was 94%.On chest auscultation,breath sound was slightly diminished on left side of chest with bilateral wheezes.There was a continuous wheezing sound,monophonic,more intense over upper chest,audible continuously during both inspiration and expiration and it was audible bilaterally.

This particular sound was new to me and I was not able to categorize it but it was heard in addition to expiratory wheezes .

On investigation the child was not anemic and there was leucocytosis with polymorph predominance and ESR was 35mm in 1 hour.

I was thinking that there might be some obstruction in large airway either lymph node or some vessels compressing it.Parents were not carrying previous Chest X-rays,so I requested to repeat the chest X-ray


On viewing the above chest X-ray ,I was sure that there is increased lucency over left lung field with hperinflation of left lung and one mass obstructing the left main bronchus .

Then I again explored the history while the child was being managed in ward with intravenous fluid,oxygen by mask,nebulization with adrenaline and injectable antibiotics.

On asking some leading questions, it was clear that there was sudden onset of cough for few seconds while the child was given some ground nuts to eat and he was eating.

Then on high index of suspicion the child was subjected directly to rigid bronchoscopy by Pediatric surgeon ,who was able to take out the pea nut form the airway of child and the child recovered and whole mystry was solved.

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