A 20-month-old boy is brought into the ED by his mother who is concerned because he woke up with a barky cough and he sounded like he was having difficulty breathing. Prior to tonight, he had 2 days of fever and a runny nose. The mother states that her son's voice sounds more hoarse than usual. The boy’s vital signs are notable for a fever of 39.2°C (102.6°F), a respiratory rate of 60 breaths/min, and a pulse oximetry reading of 98% on room air. He is not in significant acute distress when you walk into the room, but you immediately notice inspiratory stridor at rest, and subcostal retractions. The physical examination is otherwise notable for clear rhinorrhea and transmitted upper airway sounds in the lungs. The nurse asks if you would like to order urgent medications or imaging. Do you give racemic epinephrine and/or dexamethasone immediately? Is a chest x-ray necessary? How long should you observe this patient before deciding on his disposition?
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