Authors: Andrew Prossor, Graham Johnson / Editor: Steve Corry-Bass / Codes: RP5, SLO5 / Published: 04/09/2020

A 17-year-old female presents to your ED with a 6 day history of progressive dry cough, sore throat and temperatures. Today she notices she is feeling more short of breath, with a hoarse voice. 

She reports no significant past medical or family history with no regular medications or allergies. She denies contact with anybody with a similar illness. 

Initial observations showed a tachycardia of 166bpm, hypoxia at 90% in air and a respiratory rate of 42/min. The triage nurse tells you they are concerned she looks “very unwell” and you decide to move the patient to Resus for close observation. 

On examination you cannot see any obvious perioral swelling but note a tracheal tug, recruitment of accessory muscles, and a soft biphasic stridor. The chest is clear to auscultation and all other systems examinations are normal. 

Based on the initial prodrome, hoarseness, odynophagia and biphasic stridor, you decide to initiate appropriate treatment, after discussion with one of the paediatric consultants on-call. 

A chest X-ray is performed, as well as blood tests looking for any evidence of elevated CRP or elevated white cell count. After her initial treatment she is transferred to the respiratory High Dependency Unit, where she is closely monitored before making a full, uneventful recovery.