Epiglottitis and bacterial tracheitis: Viva

Branch 1: Recognising that this is not simple croup

The candidate should recognise that this child began with a typical viral croup picture but has now changed character in a way that is characteristic of bacterial tracheitis. The high fever, toxic appearance, worsening biphasic stridor, brassy cough, and crucially the failure to respond to nebulised adrenaline and corticosteroid together point away from croup and toward a bacterial tracheal infection superimposed on the preceding viral illness. The absence of drooling helps separate this from epiglottitis. ^[1]

The candidate should state that the failure of adrenaline and steroid to help is the single most useful clue, because true croup would be expected to improve, at least temporarily, with adrenaline. Anchoring on croup while a bacterial tracheitis obstructs the trachea is a recurring and dangerous error, and the deterioration overnight should trigger a complete reassessment rather than repeated doses of adrenaline. ^[3]