Stridor Differentials
Stridor:
| History | Examination | Age | Frequency | Tests | Management | |
| Croup | Associated URTI
Barking cough |
+/ fever, not toxic
high pitched stridor |
6 m6y mean 18m | Common | Nil | Supportive Steroids
Adrenaline |
| Epiglottitis | Sudden onset
Rapid progression No preceding cough URTI 2550% |
Sitting up
Toxic, pale, drooling Low pitched stridor |
90% 2yr | Rare in immunised children | Xray
Blood culture |
Antibiotics
Supportive |
| Foreign body | Possible choking episode
Food 70% Prolonged course possible 30% deaths due to balloons |
Wheeze (80%), decreased AE (50%) cough (40%) stridor (10%) resp distress (20%) fever (15%) pneumonia (15%) | 70% < 3yrs
1/3 deaths |
Potentially common | Xray – 75% sensitive, 45% specific, not sufficient to accurately exclude FB | Bronchoscopy and removal |
| Bacterial
tracheitis |
URTI for a few days High fever
Neck pain Cough (often dry) |
Unwell looking
Often prefer to lie flat |
15 years of age | Uncommon | Xray may show scalloped appearance of internal trachea | Antistaphylococcal cover
Ceftriaxone 50mg/kg IV Cefotaxime 50mg/kg IV Tazocin 5075mg/kg IV |
| Retropharyngeal abscess | Fever
Neck pain Sore throat Dysphagia |
Drooling
Hyperextension of neck, torticollis |
Usually < 6 years old
median 3 years |
Uncommon | Xray
CT |
Antibiotics
Airway management +/ surgical management |
| Trauma | Mechanical blow to neck
Chemical or thermal ingestions/inhalations |
Bruising, lacerations to ant neck, burns
Dysphagia and drooling |
Rare | Xray
Bronchoscopy |
Supportive
Surgical |
|
| Congenital
e.g. tracheomalacia subglottic stenosis, vascular anomaly |
Long term stridor
Prematurity |
Low grade stridor – may be exacerbated by URTI | < 6 months | Uncommon | Initial management as per croup Specialist referral |