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On examination you find:

  • Respiratory rate 45
  • Marked increased Work of Breathing – there is nasal flaring, deep subcostal recession and tracheal tug, and “see-sawing” of the abdomen and chest wall
  • There is obvious stridor
  • Listening to the chest, there is no wheeze. There are some transmitted upper airway sounds, and slight crackles throughout
  • Baby is not crying
  • An occasional weak, dry cough
  • Moving all 4 limbs and wriggling – baby is quite active
  • Heart rate 190
  • Baby is mottled and pale looking, central cap refill >5 seconds
  • Temperature is 36.4 degrees Celsius

Given the history and examination findings, is the most likely this an upper or a lower airway problem?

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