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Suspected paediatric epiglottitis — MRCEM SBA MCQ

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HardPaediatric emergenciesSuspected paediatric epiglottitisMRCEM SBA

A 3-year-old girl is brought to the emergency department after four hours of fever and rapidly worsening breathing difficulty. She is fully immunised. She sits leaning forward on her father's lap, drools, and has a muffled voice and soft inspiratory stridor. She has no barking cough. Her temperature is 39.4°C and oxygen saturation is 97% on air. She becomes markedly distressed when staff approach and resists being laid down. What is the most appropriate management plan now?

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

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Correct answer: C — Keep her upright with her father; summon senior anaesthetic, ENT and paediatric help to secure the airway before intravenous treatment.

The rapid onset, high fever, drooling, muffled voice and preferred forward-leaning position make epiglottitis a critical concern. Absence of a barking cough weighs against typical croup; completion of Hib immunisation does not negate the presenting airway risk. Her normal oxygen saturation is not reassuring because it may remain preserved until obstruction becomes severe. Keep her comfortable with her father, avoid provoking distress, and immediately assemble senior anaesthetic, ENT and paediatric support for controlled airway management. Give intravenous antibiotics once the airway is secure. ([cats.nhs.uk](https://cats.nhs.uk/wp-content/uploads/cats_uao_2022.pdf)) A offers appropriate treatment but puts cannulation and antibiotics ahead of airway safety. B delays care for imaging that is inappropriate in a child with severe suspected upper-airway obstruction. D resembles treatment for croup, but a response to nebulised adrenaline would not justify observation instead of urgent airway planning here. E risks distress and airway deterioration from bedside examination; visual assessment belongs within a specialist-controlled airway plan, not before one. A secured airway and subsequent intensive-care care are the appropriate disposition, rather than emergency-department observation. ([cats.nhs.uk](https://cats.nhs.uk/wp-content/uploads/cats_uao_2022.pdf))

Reference: Children’s Acute Transport Service: Upper Airway Obstruction (January 2022) — https://cats.nhs.uk/wp-content/uploads/cats_uao_2022.pdf NHS Borders: Epiglottitis (Paediatric) (Undated; next review April 2028) — https://www.rightdecisions.scot.nhs.uk/nhs-borders-clinical-guidelines/ear-nose-and-throat/epiglottitis-paediatric/ NHSGGC: Acute sore throat, Paediatrics (336) (2026) — https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/emergency-medicine/throat-infections-emergency-medicine-paediatrics-336/