Acute Upper Airway Obstruction (Epiglottitis Vs Croup)

Most children who present to the hospital with acute upper airway obstruction have croup (acute laryngo- tracheobronchitis) or epiglottitis. Other differential diagnoses include bacterial tracheitis, foreign body inhalation and angioneurotic oedema.

You have to assess severity by examination of

• constitutional state (toxicity, fever, pulse rate)
  
• stridor
  
• drooling
  
• cough
  
• speech
  
• tachypnoea
  
• tracheal tug on inspiration
  
• intercostal and subcostal indrawing on inspiration
  
• asynchrony of chest and abdominal wall movement
  
• cyanosis in air

Guidelines For The Diagnosis Of Croup And Epiglottitis:

Note: Each of these clinical signs in isolation is a poor discriminator however, considered together, they usually allow the correct diagnosis to be made.

Important Notes

1. All children with stridor must be reviewed by the paediatric admitting officer before discharge home or admission to the ward.
2. If the child is cyanosed he is likely to die very quickly -notify paediatric ICU immediately. The aim is to transfer severely obstructed children to ICU before intubation becomes imperative, as it is preferable to intubate them in ICU.
3. as a child becomes physically exhausted the stridor, indrawing and air entry may decrease.