Croup in a young girl at a school carnival

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. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
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 urgent ambulance via CSP given paediatric respiratory presentation with stridor at rest. Pre-advise CSP.
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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