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Bacterial tracheitis — RACP Paediatrics MCQ

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HardRespiratoryBacterial tracheitisRACP Paediatrics

A toxic 4-year-old has progressive stridor, thick secretions and poor response to croup therapy. Air entry is falling and bacterial tracheitis is suspected. What is the safest immediate approach?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Minimise distress and involve senior anaesthetic or ENT airway staff

Explanation lettering: E = shown as C · C = shown as E

C is correct because severe upper-airway obstruction can decompensate abruptly; the child should be minimally handled and the most experienced airway team involved, with a smaller tube anticipated. D may precipitate complete obstruction. E prioritises imaging over airway safety. A removes compensatory tone and delays definitive management. B may provide a temporary bridge but does not treat purulent mechanical obstruction or replace airway and antimicrobial management.

Reference: Royal Children’s Hospital Melbourne, Acute upper airway obstruction: https://www.rch.org.au/clinicalguide/guideline_index/Acute_Upper_Airway_Obstruction/