Noisy Breathing

  • 3m/o boy BIB parents

    p/w noisy breathing

    Hx: 2/7 coryza, 1/7 cough, 3 hours of noisy breathing

  • Distressed

    A: Biphasic stridor

    B: RR 89% ra, mod WOB, chest clear

  • Life Threatening Croup (laryngeotracheobronchitis)

  • • Laryngotracheobronchitis

    • Inhaled foreign body

    • Anaphylaxis

    • Epiglottitis

    • Rare causes include:

    – Bacterial tracheitis

    – Severe tonsillitis with very large tonsils

    – Inhalation of hot gases (e.g. house fire)

    – Retropharyngeal abscess

  • 1) Minimal handling
    2) Adrenaline neb
    - with 15L O2
    - repeat until hypoxia improved
    3) Dexamethasone IM
    4) If repeat adrenaline nebs required: call for anaesthetic backup for potential intubation
    5) If improving:
    - 4hours observation post adrenaline neb
    - parental advice / safety netting
    - dc when stridor free at rest

  • RCH Croup CPG

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