Two minutes after removing an endotracheal tube from a 10-year-old, moderate inspiratory stridor develops. The most appropriate action would be to

• A. Administer oxygen
• B. Administer racemic epinephrine
• C. Manually ventilate using bag and mask
• D. Re-intubate the patient

Answer: (A)

Post-extubation stridor signals upper airway edema causing partial obstruction. The immediate goal is to keep oxygenation and ventilation adequate while the swelling settles. Providing supplemental oxygen delivers a higher fraction of inspired oxygen to maintain oxygen saturation and reduce the work of breathing, which is the best first step when the airway is still patent enough for spontaneous breathing.

Manual ventilation with a bag and mask isn’t the initial move here because there isn’t evidence of poor ventilation or apnea yet; if the patient began to hypoventilate or stop breathing, that would change the plan. Re-intubation is reserved for when airway obstruction worsens or gas exchange cannot be maintained; in a stable child with moderate stridor, it’s not the first action. Racemic epinephrine can be useful for reducing airway edema in some cases, but the most appropriate initial step is to ensure adequate oxygenation with supplemental oxygen and monitor the response, escalating therapy only if the stridor progresses or the patient shows signs of respiratory distress.