Respiratory

Croup in a young girl at a school carnival

Foundation

Pediatric · 8yr · female

Patient Information

Dispatch	You are called to the FAP at Riverside Primary School Carnival. A parent has brought in her 8-year-old daughter who has developed a barking cough and noisy breathing. (Mia Nguyen, 8YO female)
Patient	Mia Nguyen — 8yr (25kg)
Incident History	Pt presented to FAP with mum. Mum states Mia had a runny nose and mild temperature since yesterday. Tonight she woke with a barking cough and noisy breathing. Symptoms worsened on the way to the event this morning.
Emergency Contact	Linh Nguyen (Mother) — 0412 387 654

Initial Rapid Assessment

Response	Alert
Airway	Patent. Audible stridor present at rest. No drooling. No foreign body suspected.
Breathing	Increased work of breathing. Audible stridor on inspiration. Mild intercostal recession. RR elevated. SpO2 94% on room air.
Circulation	Radial pulse present, regular, slightly elevated rate. Skin warm, mild pallor. CRT less than 2 seconds.
Disability	GCS 15 (E4V5M6). Alert and oriented to time, place and person. Mildly anxious. Clingy to mother.
Exposure	No rashes, no urticaria, no visible injuries. Mild nasal flaring noted. No tracheal tug at rest.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	94% (RA)	Moderate	30	118	100/65	<2s	15	4 4 ++	38.1	–	2
10 mins	98% (O2 NRB 10L/min)	Mild	24	108	102/66	<2s	15	4 4 ++	38.1	–	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from moderate croup (acute laryngotracheobronchitis) presenting with audible stridor at rest, barking cough, mild intercostal recession, and low-grade fever in a paediatric patient.

Facilitator Triggers — if trainees miss a critical step

! (If the officer attempts to forcibly reposition Mia or insists she lie flat — mum states Mia is resisting and becoming more distressed. Stridor audibly worsens. Remind trainee: do not forcibly change a child's posture; allow position of comfort.)
! (If oxygen is not applied within 3 minutes of assessment — Mia's SpO2 drops to 92% on room air and work of breathing visibly increases. Mum becomes anxious and asks if Mia is getting worse.)
! (If the trainee does not reassess for rapid deterioration after 5 minutes — facilitator prompts: 'Mia's breathing seems to be getting louder. What are you monitoring for?')
! (If the trainee attempts to administer salbutamol — facilitator advises: there is no wheeze present and no diagnosis of asthma. Croup does not respond to bronchodilators. Reassess clinical picture.)
! (If the trainee does not arrange transport — facilitator prompts at 8 minutes: 'Mum is asking if Mia needs to go to hospital. What is your plan?')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE including gloves.
2. Perform Primary Survey — assess DRABC. Confirm airway patent with stridor present, breathing with increased work of effort, circulation intact.
3. Allow Mia to remain in a position of comfort with her mother — do NOT forcibly reposition the child.
4. Perform Vital Sign Survey — SpO2, RR, HR, BP, temperature, GCS.
5. Administer oxygen via appropriately sized paediatric face mask titrated to target SpO2 ≥95% — commence at 6–8 L/min via simple face mask, adjust as required.
6. Continuously reassure Mia and her mother — keep Mia calm as agitation worsens stridor.
7. Perform secondary survey once child is settled — observe for intercostal recession, tracheal tug, nasal flaring, pallor or mottling.
8. Classify croup severity: Moderate — audible stridor at rest, mild sternal recession, barking cough, mildly irritable.
9. Monitor persistently for signs of rapid deterioration: worsening stridor, increasing recession, pallor and mottling, drooling, lethargy — these indicate severe croup requiring urgent escalation.
10. Arrange transport — notify ambulance for Priority 1 transport given paediatric respiratory presentation with stridor at rest. Pre-notify receiving facility.
11. Record full observations every 5 minutes given paediatric time-critical respiratory presentation.
12. Document all findings and interventions on ePCR.
13. Scenario ends on arrival of ambulance and IMISTAMBO handover.
14. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Croup (acute laryngotracheobronchitis) · Dyspnoea & Respiratory Distress · Oxygen Delivery · Primary Survey · Pulse Oximetry

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Signs/Symptoms	Barking cough, audible stridor at rest, mild intercostal recession, mild nasal flaring, increased work of breathing, low-grade fever.
Allergies	NKDA — no known drug allergies.
Medications	Nil regular medications.
Pertinent History	Nil significant past medical history. No previous episodes of croup. No known asthma. Born full-term, no respiratory conditions.
Last Oral Intake	Small amount of water approximately 1 hour ago. Light breakfast this morning.
Events Leading	Mia attended the school carnival with her family. Mum noticed the barking cough worsening while at the event and brought her to the FAP.
Treatment Prior	Mum brought Mia inside to the FAP. No medications given prior to arrival. Mum encouraged Mia to stay calm.

Onset	Runny nose and mild temperature since yesterday evening. Woke overnight with barking cough. Worsened this morning.
Pain	Mia describes mild throat discomfort. 2/10.
Quality	Barking, seal-like cough. Inspiratory stridor audible at rest.
Radiates	Nil
Severity	2/10 throat discomfort. Moderate respiratory distress.