Paediatric Upper Airway Obstruction

Question 1

Is epiglottitis time critical?

Answer 1

Yes.

Question 2

What are indicators of epiglottitis, and how are they differentially diagnosed to croup?

Answer 2

1. Stridor
2. Increased WOB
3. Drooling
4. An absence of cough
5. Low pitched expiratory stridor (often snoring)
6. Pt prefers to sit in a tripod or sniffing position

Croup is more likely to present with a cough and absence of drooling.

Question 3

Should the airway of pts suspected to have epiglottitis be inspected? Why?

Answer 3

No, may precipitate respiratory arrest.

Question 4

What is the management if a child has a partial obstruction with an effective cough?

Answer 4

Passive techniques:

• use gravity
• encourage cough
• maintain BLS

Question 5

What is the management if a child has a partial obstruction with an ineffective cough but is conscious?

Answer 5

Use manual techniques:

• use gravity
• back slaps alternating with chest thrusts

Question 6

What is the management if a child has a partial obstruction with an ineffective cough and is unconscious?

What should be done if there is a loss of C.O?

Answer 6

• chest compressions
• suction
• magill’s forceps
• forced ventilation

Mx as per Cardiac Arrest if loss of C.O.

Question 7

Can the paediatric upper airway obstruction guideline be applied to newborns?

Answer 7

No, use suctioning as per newborn resus guideline.

Question 8

What is a sign of deterioration in pt condition in croup?

Answer 8

Decreased cough/stridor and increasing lethargy.

Question 9

When is nebulised adrenaline indicated in croup?

Answer 9

Pt presenting with signs of hypoxia or who’s condition is deteriorating.

Question 10

What are the 5 assessed elements of croup as per the RCH croup severity table?

Answer 10

Behaviour, stridor, respiratory rate, accessory muscle use, oxygen.

Question 11

What are the findings associated with mild croup as per the RCH croup severity table?

Answer 11

Behaviour - normal
Stridor - barking cough, stridor only when active/upset
RR - normal
Accessory muscle use - none or minimal
Oxygen - no oxygen requirement

Question 12

What are the findings associated with moderate croup as per the RCH croup severity table?

Answer 12

Behaviour - some/intermittent irritability
Stridor - some stridor at rest
RR - increased, tracheal tug, nasal flaring
Accessory muscle use - moderate chest wall retraction
Oxygen - no oxygen requirement

Question 13

What are the findings associated with severe croup as per the RCH croup severity table?

Answer 13

Behaviour - increasing irritability and/or lethargy
Stridor - stridor present at rest
RR - marked increase or decrease in RR, tracheal tug, nasal flaring
Accessory muscle use - marked chest wall retraction
Oxygen - hypoxaemia (late sign)

Question 14

What is the management for mild croup?

Answer 14

BLS, monitor for deterioration (Rx as per severe is required)

Question 15

What is the management for moderate croup?

Answer 15

Dexamethasone 600mcg/kg oral, Max. 12mg
Transport
Monitor for deterioration (Rx as per severe if required)

Question 16

What is the management for severe croup?

Answer 16

1. Dexamethasone 600mcg/kg oral, Max. 12mg
2. Adrenaline 5mg in 5mL nebulised
   - Can rpt at 5 min intervals until improvement
3. Transport
4. Continue to monitor pt

Question 17

Under the croup flowchart, what are the 3 possible indicators that a pt has severe croup?

Answer 17

Either:

• Increasing respiratory distress
• Increasing lethargy
• Decreasing stridor

Question 18

What is the Mx for suspected epiglottitis?

Answer 18

1. BLS
2. Transport
3. Do not inspect the airway!!