Regarding aspects of acute stridor in children,
which one of the following statements is CORRECT?
a) Respiratory syncytial virus (RSV) most commonly
causes laryngotracheobronchitis
b) Because of the potential for complete airway
obstruction, an intravenous cannula
should be sited as a priority
c) Steroids no longer have a place in the treatment
of croup
d) Once intubated, patients with a diagnosis of
croup tend to have longer time to
extubation than those with epiglottitis
e) A two day history of high fever and barking cough
in a 4-year-old is typical for a
diagnosis of croup
Answer: d
Explanation
This question focuses on just one cause of acute
stridor in children (croup) although the
candidate should be familiar with croup,
epiglottitis, bacterial tracheitis and foreign
body aspiration. The commonest cause of croup is
parainfluenza virus. Although it
may be caused by the respiratory syncytial virus
(RSV), the commonest manifestation
of RSV infection is bronchiolitis or pneumonia, not
croup. It is accepted practice that
disturbance or distress of the stridulous child
should be avoided at the risk of precipitating
complete airway obstruction. This includes
postponing placement of an intravenous
cannula until after stability has been achieved. The
treatment of croup involves
humidified oxygen, nebulised adrenaline
and steroids. Heliox may be useful if high
inspired concentrations of oxygen are not required.
Time to extubation tends to be 48
hours with epiglottitis but if croup has been severe
enough to warrant intubation,
extubation may take up to ten days. A two day
history of high fever and barking cough
in a four-year-old is not typical. Although the
onset and barking cough are usual, the
patient is a little old for croup and a low-grade
pyrexia is more common. A rapid onset,
high grade fever in a very unwell 4-year-old with
stridor is more consistent with
epiglottitis.
Reference
Maloney E, Meakin G. Acute stridor in children. Contin Educ Anaesth Crit
Care Pain
2007; 7(6): 183–6.
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