Croup in a child at a school carnival

Patient Information

Dispatch: You are called to the FAP at Riverside Primary School Carnival for an 8-year-old boy (Lachlan Doyle) brought in by a teacher. The child has a noisy, barking cough and is having trouble breathing.
Patient: Lachlan Doyle — 8yr (26kg)
Incident History: Lachlan presented to the FAP with a harsh barking cough that started approximately 20 minutes ago. His teacher states he has had a runny nose and mild temperature for the past two days. He has been at the carnival all morning and became distressed when his cough worsened.
Emergency Contact: Michelle Doyle (Mother) — 0412 773 095

Initial Rapid Assessment

Response: Alert
Airway: Upper airway partially obstructed. Audible stridor at rest. No drooling. No foreign body visible.
Breathing: Increased work of breathing. Audible stridor. Mild intercostal recession. RR elevated. Child is sitting upright in position of comfort — do not force position change.
Circulation: Radial pulse present, regular, slightly elevated. Skin warm and pink. CRT <2s.
Disability: GCS 15 (E4V5M6). Alert and oriented. Mildly anxious. No altered conscious state.
Exposure: No rashes, no urticaria. No visible injuries. Child flushed in face. Mild nasal flaring noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	94% (RA)	Moderate	28	118	100/65	<2s	15	4 4 ++	37.9	–	2
10 mins	98% (O2 simple mask 6L/min)	Mild	22	104	100/65	<2s	15	4 4 ++	37.9	–	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from moderate croup (acute laryngotracheobronchitis) presenting with audible stridor at rest, barking cough, mild sternal recession, and mildly reduced SpO2 on room air.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee attempts to force Lachlan into a supine position — facilitator states: Lachlan becomes highly distressed, begins crying, stridor worsens markedly, and SpO2 drops to 90%. Allow the child to remain in his position of comfort.)
! (If oxygen is not applied within 3 minutes of assessment — facilitator states: SpO2 drops to 91% on room air and Lachlan becomes more visibly distressed with increased sternal recession. Prompt: 'What does Lachlan's SpO2 tell you and what can you do?')
! (If the trainee does not call for ambulance/higher-level care — facilitator states: After 8 minutes, Lachlan's stridor becomes louder and more continuous. His mother arrives and asks 'Is he going to be okay? Does he need to go to hospital?' Prompt trainee to consider transport decision and IMISTAMBO handover.)
! (If the trainee attempts to administer salbutamol — facilitator states: There is no wheeze present and this is not a diagnosis of asthma or anaphylaxis. Croup does not respond to bronchodilators. Redirect trainee to the Croup CPG.)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE including gloves.
2 Perform Primary Survey — identify moderate croup with airway compromise (stridor at rest, barking cough, intercostal recession).
3 Allow Lachlan to remain in his position of comfort (seated upright) — do NOT force position change.
4 Administer oxygen via simple face mask at 5–8 L/min — titrate SpO2 to target ≥95% in paediatrics. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
5 Perform Vital Signs Survey — GCS, RR, SpO2, HR, BP, temperature, pain score.
6 Obtain SAMPLE history from child and teacher — confirm no foreign body, no previous croup, no allergy.
7 Contact emergency contact (mother Michelle Doyle — 0412 773 095) and advise of situation.
8 Reassess every 5–10 minutes — document vital signs and monitor closely for rapid deterioration.
9 Escalate to higher care — Lachlan has moderate croup with stridor at rest requiring Advanced Care assessment. Call CSP for urgent ambulance.
10 Pre-advise CSP of 8-year-old male with moderate croup, stridor at rest, SpO2 94% on room air, improving with oxygen.
11 Continuously reassure Lachlan and his teacher — keep environment calm and quiet to minimise distress.
12 Do NOT administer salbutamol — croup is not bronchospasm; salbutamol has no role in croup management.
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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