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Croup versus epiglottitis — DIPIMC MCQ

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HardPaediatric and Obstetric EmergenciesCroup versus epiglottitisDIPIMCDipIMC

A 3-year-old has a 2-day history of a barking cough, hoarse voice and mild stridor that is worse when he is upset, but he is alert, drinking and not drooling, with a low-grade fever. What is the most appropriate management?

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Correct answer: A — Keep the child calm and give corticosteroid, avoiding distress

The history of a barking cough, hoarse voice and stridor in a well, drinking child suggests croup, which is managed by keeping the child calm, giving a steroid (oral dexamethasone or nebulised budesonide) and oxygen if required, while avoiding upsetting procedures. Examining the throat or forcing a cannula can precipitate complete obstruction if the diagnosis is instead epiglottitis. Drooling, toxicity and a quiet, still child point towards epiglottitis rather than croup. Pearl: distress worsens upper-airway obstruction, so minimal handling is part of treatment.

Reference: APLS; JRCALC Clinical Guidelines