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Primary care emergencies - stridor

GPs Dr Chantal Simon, Dr Karen O’Reilly, Dr Robin Proctor and Dr John Buckmaster advise on how cases should be managed

GPs Dr Chantal Simon, Dr Karen O'Reilly, Dr Robin Proctor and Dr John Buckmaster advise on how cases should be managed

Croup

The cough typically starts at night and is exacerbated by crying and parental anxiety. Some children have recurrent attacks associated with viral upper respiratory tract (URTI).

Management

• Steam helps.
• There is evidence that nebulised steroids can be helpful, but most GPs don't carry them.
• Admit as a paediatric emergency if there is intercostal recession, cyanosis or the child's carers are unable to cope.

Acute epiglottitis

Bacterial infection causing a swollen epiglottis. Potentially, can obstruct the airways. Much rarer since introduction of routine Haemophilus influenzae type b (Hib) immunisation.

Presentation Look for stridor, drooling, fever, upright leaning forward posture. If suspected, don't examine the child's throat as this can precipitate complete obstruction.

Management

Child: refer as an emergency but try to maintain a calm atmosphere to avoid distressing the child. Examination will be undertaken in hospital with full resuscitation facilities on hand. Treatment is IV antibiotics.

Adult: adult epiglottitis is less likely to cause complete airway obstruction but still has a 5-10% mortality. Refer as an emergency for IV antibiotics.

Laryngomalacia

Congenital laryngeal stridor is common among small babies, because of their floppy aryatic folds and the small size of the airways in young children. Stridor becomes more noticeable during sleep, excitement, crying and with concurrent URTIs. Normally resolves without treatment but parental concern may necessitate referral.

Inhaled foreign body

Refer as an emergency to ENT for assessment.

This is an extract from Emergencies in Primary Care published by Oxford University Press, edited by Dr Chantal Simon, a GP in Dorset and MRC health service research fellow at the department of primary medical care, Southampton University Medical School; Dr Karen O'Reilly, a GP in Hampshire; Dr Robin Proctor, a GP in Surrey; and Dr John Buckmaster, a GP in the Outer Hebrides. To order a copy go to www.oup.co.uk ISBN:978-0-19-857068-4 or click on the link on the right of the screen

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