Upper-airway obstruction and stridor — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in the emergency department. A two-year-old boy presents at 1 am with a two-day coryzal prodrome and an overnight barking, seal-like cough, a hoarse voice and inspiratory stridor when upset. Initially he is alert, pink and drinking with mild recession. Over the next 30 minutes he develops inspiratory stridor at rest, increasing intercostal and suprasternal recession and tracheal tug, and becomes more distressed. The team asks you to establish the diagnosis and severity, deliver the immediate management with doses, apply the do-not-distress principle, and set the escalation and safety-netting plan. You have 12 minutes with the team and 5 minutes for examiner discussion. ^[1]