ABSTRACT
You are asked to see a 2-year-old child with difficulty in breathing, a runny nose and a barking cough. His mother tells you he had a heart defect repaired as a baby and he still has a murmur. On examination he has noisy breathing with mild subcostal recession. He is apyrexial with a respiratory rate of 44 breaths per minute and heart rate of 152 beats per minute; capillary refill is 1-2 seconds. His throat is red and the tonsils are enlarged with no exudate. On his chest you see a midline sternotomy scar with a drain scar and a right thoracotomy scar. On auscultation the lung fields are clear, but he has an ejection systolic murmur in the left upper sternal edge which radiates to the back. He does not have a gallop rhythm. There are transmitted upper airway sounds only on the lung fields and the abdomen is soft with no organomegaly. What is the most appropriate management?
