Diagnose it yourself – DIY – The Baby That Can’t Breathe

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

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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