🫁 Respiratory Distress · Stridor · Wheeze · Retractions · Epiglottitis · Croup · Asthma · FB

Schwartz Clinical Handbook — Chapter 66 · Upper vs lower obstruction · Barking cough (croup) · Inspiratory stridor · Expiratory wheeze · Grunting · Retractions

Select onset (acute, subacute), stridor (inspiratory, biphasic), wheeze (expiratory), fever, drooling, cough quality, and position (sniffing, tripod) → differentiate croup, epiglottitis, bacterial tracheitis, foreign body, asthma, bronchiolitis, and retropharyngeal abscess.
⚠️ Red flags: stridor, drooling, toxic appearance → epiglottitis (do not examine pharynx, immediate airway). Biphasic stridor → subglottic or tracheal lesion.

📋 Step 1 — Work of breathing & sound
📌 Diagnostic impressions
📖 Schwartz Ch 66

Select stridor (inspiratory, biphasic, expiratory), wheeze, retractions, grunting, cough quality (barking, staccato), fever, drooling, positioning, and age → differentiate croup (viral laryngotracheobronchitis), epiglottitis (Hib, stridor, drooling, toxic), bacterial tracheitis, foreign body, asthma, bronchiolitis (RSV), and retropharyngeal abscess.

✔️ Croup: barking cough, inspiratory stridor, worse at night, responds to steroids.
✔️ Epiglottitis: toxic, drooling, tripod position, thumbprint sign (do not examine).
✔️ Asthma: expiratory wheeze, prolonged expiration, history atopy.
✔️ Bronchiolitis: infant, wheeze, rhinitis, RSV season.
✔️ Foreign body: sudden onset, focal wheeze, inspiratory/expiratory CXR.
📘 Schwartz pearls (Chapter 66)
• Croup: dexamethasone 0.6 mg/kg PO/IM (single dose). Racemic epinephrine if moderate‑severe.
• Epiglottitis: do not examine pharynx, immediate anesthesia, blood culture, ceftriaxone.
• Asthma: albuterol + ipratropium, steroids. Hypoxia → oxygen.
• Foreign body: bronchoscopy rigid.
• Retropharyngeal abscess: lateral neck X‑ray (prevertebral swelling), CT, IV abx, ENT drainage.