Pediatric Presentation of Acute Onset of Neck and Chest Pain

A 15 yo presents to your ED with an acute onset of neck and chest pain approximately 4 hours prior to presentation. He states that he was helping prepare a surprise birthday for his mother by inflating balloons with a helium tank.

The chest pain is worsened with deep inspiration and radiates to his neck. His mother says his neck appears swollen, but the patient states he has been working out recently to try out for his high school’s football team.

There is no history of fever, cough, URI symptoms, vomiting. Past medical history is significant for asthma with hospitalizations when he was younger, but none in the past 5 years. He denies any drug use. On exam, he is awake, alert in mild respiratory distress.

VS: T 36.5°C HR 90 RR 38   BP 120/72 SpO2 95% on RA.

He has neck tenderness/swelling along the sternocleidomastoid muscles bilaterally but has good FROM without midline cervical tenderness. There is fair aeration bilaterally, but decreased breath sounds in all lung fields. There is no reproducible chest pain.

The following CXR is obtained:

Which should be the next step in the treatment of this patient?

• Oral analgesics
• Peak expiratory-flow rate measurement
• Chest tube
• Albuterol/ipatropium nebulized treatment

This question appears in Med-Challenger Pediatric Emergency Medicine Exam Review with CME - 3rd Edition

 

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