What is the first step a respiratory therapist should take for a 5-year-old child with wheezing on one side and normal breath sounds on the other?

• A. Perform bedside pulmonary function testing
• B. Perform an ABG
• C. Order a spiral CT scan
• D. Obtain a chest radiograph

Answer: (D)

The first step in managing a 5-year-old child presenting with wheezing on one side is to obtain a chest radiograph. This imaging study is crucial as it helps to identify potential underlying causes of the unilateral wheezing. Potential conditions include foreign body aspiration, pneumonia, or other structural abnormalities in the lung. Obtaining a chest radiograph is a non-invasive and rapid way to gain insight into whether there is something obstructing airflow, such as a foreign body, or if there are signs of infection that could affect breath sounds.

On the other hand, bedside pulmonary function testing may not be appropriate, especially in younger children who may not be able to cooperate with the testing process. Performing an arterial blood gas (ABG) analysis could provide information on the child’s acid-base status and gas exchange, but it does not directly address the cause of the wheezing. Ordering a spiral CT scan is generally not the first step due to its complexity, the radiation exposure involved, and the need for more immediate examination to ascertain the cause of the wheezing. Thus, obtaining a chest radiograph is the logical first step in assessing this clinical situation.