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A diagnosis not to get stuck on
  1. Karen Keown1,
  2. Caroline Hart1,
  3. Michael Moran2,
  4. Andrew Thompson1
  1. 1Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2Department of ENT, Royal Victoria Hospital, Belfast, UK
  1. Correspondence to Dr Karen Keown, Royal Belfast Hospital for Sick Children, Belfast BT12 6BE, UK; karen.keown{at}

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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, …

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  • Contributors KK, CH, MM and AT were involved in the writing and clinical review of the case and the patient.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.