Croup and Airway Obstruction
Prereading :
| CHQ Croup Guideline |
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Workbook Cases :
Case 1
A 3-year-old boy presents with sudden onset barking cough overnight. He seemed to have very noisy breathing at home but this has settled prior to presentation. He now examines well with no work of breathing but still has an intermittent barking cough.
Case 2
A 2-year-old girl presents with her father with loud stridor and associated increased work of breathing. She was well before she went to bed but woke up suddenly with a barking cough and significant stridor. On examination, she is febrile, has moderate to severe tracheal tug and subcostal recessions with loud stridor. Her RR is 40 and Sats are 96%
Case 3
A 4-year-old boy was playing with a coin when he accidentally inhaled it and started choking. After coughing for a few minutes, he had a colour change around his lips. On arrival to ED he was sitting up and drooling with soft stridor.
Case 4
A 12-year-old female who is allergic to peanuts was at a friend’s house eating banana bread when suddenly she felt a tightness in her throat. She tried taking 10mg cetirizine but started vomiting. Her friend’s mum drove her to ED. On arrival, her obs are HR 120, RR 30, Sats 92% and BP 88/64. She has a hoarse voice and global wheeze and appears to be quite pale.
Case 1
A 3-year-old boy presents with sudden onset barking cough overnight. He seemed to have very noisy breathing at home but this has settled prior to presentation. He now examines well with no work of breathing but still has an intermittent barking cough.
- How would you treat him?
- How long does he need to stay in the emergency department? What advice will you give to his parents on discharge?
Case 2
A 2-year-old girl presents with her father with loud stridor and associated increased work of breathing. She was well before she went to bed but woke up suddenly with a barking cough and significant stridor. On examination, she is febrile, has moderate to severe tracheal tug and subcostal recessions with loud stridor. Her RR is 40 and Sats are 96%
- What is your immediate management?
- Following this management, she responds well. How long should she stay in the department and what would your discharge criteria be?
- If she had no improvement after the initial management, how would you escalate your management?
- If she was unimmunized how would this change your management?
Case 3
A 4-year-old boy was playing with a coin when he accidentally inhaled it and started choking. After coughing for a few minutes, he had a colour change around his lips. On arrival to ED he was sitting up and drooling with soft stridor.
- What are your concerns with the above presentation? What would be your management priorities?
- Imaging reveals a $1 coin in the upper airway, what are the next steps you would take?
Case 4
A 12-year-old female who is allergic to peanuts was at a friend’s house eating banana bread when suddenly she felt a tightness in her throat. She tried taking 10mg cetirizine but started vomiting. Her friend’s mum drove her to ED. On arrival, her obs are HR 120, RR 30, Sats 92% and BP 88/64. She has a hoarse voice and global wheeze and appears to be quite pale.
- What is the first management step including the dose and route of administration?
- As well as the initial drug are there any other medications you would deliver?
- How long would you keep her in the department for?
- Where can you find discharge information on anaphylaxis and how will you prescribe an epi pen?