Emergency drug & fluid calculator

The signs of partial acute upper airway obstruction are:

• Stridor.
• Increased work of breathing as evidenced by suprasternal, intercostal, and subcostal retraction along with an increased use of accessory muscles of respiration.

Signs of deterioration and indications for urgent intervention are:

• Hypoxia - worried, unsettled appearance, restlessness.
• Fatigue or decreasing conscious state.
• Increasing work of breathing.

Discuss all children with severe or deteriorating upper airway obstruction with a consultant urgently

• call ICU x5211
• Or call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

Assessment

• A harsh, barking cough in a febrile, miserable, but otherwise well child suggests Croup.
• Absent cough with low pitched expiratory stridor (often snoring) and drooling suggests epiglottitis.
• Sudden onset in an otherwise well child with coughing, choking and aphonia suggests an inhaled foreign body.
• Swelling of face and tongue, wheeze or urticarial rash suggests Anaphylaxis.

Other possible diagnoses

Note: There is a high degree of overlap in clinical presentation between epiglottitis, bacterial tracheitis and upper airway abscess.

Management

• Allow child to settle quietly on parent's lap in the position the child feels most comfortable.
• Observe closely with minimal interference.
• Treat specific cause - refer to  Croup, Anaphylaxis and Foreign Body in the Airway guidelines.
• Call PICU if worsening or severe obstruction.
• Oxygen may be given while awaiting definitive treatment. This can be falsely reassuring because a child with quite severe obstruction may look pink in oxygen.

Notes

1. Intravenous access should be deferred - upsetting the child can cause increasing obstruction.
2. Lateral cervical soft tissue x-rays do not assist in management.
   In severe airways obstruction x-rays cause undue delay in definitive treatment and may be dangerous (positioning may precipitate respiratory arrest).