A diagnosis not to get stuck on

Abstract

A 2-year-old girl presented to the local emergency department with 4 days of vomiting, poor oral intake and fever. ‘Noisy’ breathing and cough were noted by her parents in the preceding 12 h. She was initially given oral antibiotics for tonsillitis before developing audible stridor. Oral and nebulised steroids were given for presumed croup, and she was transferred to the nearby paediatric emergency department for further management. Intravenous access was established prior to transfer. On paediatric assessment, she appeared pale and sitting in a tripod position with her neck in extension. Soft inspiratory stridor was present with a loud, wet barking cough. Oxygen saturations were maintained with wafting oxygen but desaturated when distressed. She was tachycardic though capillary refill was normal. Intravenous ceftriaxone was administered to cover for bacterial tracheitis, and although she was maintaining her own airway, …