Stridor in the Pediatric Patient

Case Conclusions

Case 1

The 9-month-old boy with stridor was noted to have increased stridor while fussy, but even at rest some inspiratory stridor was present. A barky cough was noted in the examination room. The patient was placed on a monitor and a nebulized racemic epinephrine treatment was started. A single dose of oral dexamethasone was given shortly after presentation to the ED. Since the patient had inspiratory stridor at rest with associated tachypnea and hypoxia on initial presentation, a neck X-ray was obtained (Figure 4). Subglottic narrowing was identified on the imaging, but both the epiglottis and the prevertebral space were normal in appearance and no foreign bodies were visualized. The inspiratory stridor at rest, tachypnea, and mild hypoxia all improved after treatment, the patient was observed for 2 hours in the ED without recurrence of respiratory distress and was able to be discharged home with a diagnosis of acute croup.

Figure 4.

Case 2

The 3-year-old girl was noted to be in significant positional respiratory distress, so the physician asked her parents to keep her calm in her position of comfort. She was calmly and quickly placed on a monitor with age-appropriate distraction techniques in place and advanced airway equipment at the bedside. A portable chest X-ray was obtained and revealed a coin was partially obstructing the trachea. Care was taken in the ED to avoid all interventions such as IV access that might upset the child so as not to inadvertently convert this partial airway obstruction to a complete obstruction. The otolaryngology team was called urgently, and the patient was transported to the operating room for foreign body removal in a controlled environment.