352 Paediatric Emergencies
Stridor
2 Assess and secure the airway and give high-f low oxygen by face mask.
(i) Call the senior ED doctor for assistance if signs of upper
airway obstruction secondary to laryngeal oedema occur, for
consideration of urgent endotracheal intubation.
3 Prepare to give adrenaline (epinephrine).
(i) Give 1 in 1000 adrenaline (epinephrine) 0.01 mg/kg (0.01 mL/kg)
i.m. for a significant reaction.
(ii) Give 1 in 1000 adrenaline (epinephrine) 5 mL nebulized if the
airway is obstructing to reduce laryngeal oedema.
4 Otherwise insert an i.v. cannula now and administer a f luid bolus of
10–20 mL/kg normal saline for tachycardia and hypotension.
(i) Intravenous adrenaline (epinephrine) is only indicated in
critical shock, when muscle blood flow is reduced, or impending
respiratory arrest. Give the adrenaline (epinephrine) i.v. slowly,
providing the child is monitored in a resuscitation area
(a) put 1 in 1000 adrenaline (epinephrine) 0.15 mg/kg (0.15 mL/
kg) in 50 mL normal saline, and start at 1 mL/h equivalent
to 0.05 g/kg per minute, up to 100 mL/h in critical
deterioration.
(ii) Admit the child to the ICU.
5 Give hydrocortisone 4 mg/kg i.v. for refractory bronchospasm and add
regular nebulized salbutamol 2.5 mg if under 5 years of age, and 5 mg if over
5 years.
6 Refer all patients immediately to the paediatric team for admission, an
anaphylaxis management plan and immunology follow-up.STRIDOR
This is an inspiratory noise originating from airway obstruction around or above
the level of the larynx. There are three important causes:
● Croup (acute laryngotracheobronchitis)
● Epiglottitis
● Inhaled foreign body.Croup (acute laryngotracheobronchitis)
DIAGNOSIS
1 Croup is a viral infection primarily involving the larynx and subglottic area,
most commonly due to parainfluenza viruses. It usually occurs in winter
and affects children aged between 1 and 3 years.