Pitfalls

>20% of children presenting with acute stridor do not have croup. If an alternative diagnosis is not sought then serious differentials could be missed.
In children who present with a sudden onset of stridor a foreign body should be considered.
Children with epiglottitis should not have the oropharanx examined as this can cause total airway obstruction. Diagnosis is clinical and confirmed when the child is intubated.
In a patient presenting with anaphylactic symptoms that do not respond to adrenaline, hereditary angioedema should be considered. Hereditary angioedema does not respond to adrenaline and C1 inhibitor concentrate should be given. Fresh frozen plasma should be used taking care not to cause fluid overload and pulmonary oedema.