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What Should I Treat It As?

Posted Jan 07 2009 6:03pm
A young girl, just about 2 years old, presented to me with coryza, cough and fever for 1 day. Parents noted increasingly worsening noisy breathing for the past 1 day. When I met the girl, she has audible wheeze and mild stridor. She had some tracheal tugging, and mild intercostal recession. Her chest had some scattered wheeze, no crepitations.

Now, it's decision time. Should I treat her as a viral-induced wheeze or croup?

I don't know.

So I rationalised to myself.
Right, her wheeze is more prominent...and she has got some wheeze in her chest. Hence, I should give her a steroid (prednisolone) and bronchodilator.

Or, should I treat her as a croup.....but then again, the treatment is also a steroid (dexamethasone).

Hmm.....hmmm....hmmm

Fine. I decided that I would treat it as a viral induced wheeze. Halfway through giving her the bronchodilator, her stridor became more prominent...and she actually started to cough..and that cough was a croupy cough. Hence, I changed my mind and treated her as a croup. I gave her dexamethasone instead.

Later on, I informed my reg about this. He said that he would have just given her the prednisolone anyway, because, during the olden days, prednisolone was the gold standard for either wheeze or croup. Oh well....decision has been made. At least she got a steroid of some sort. But decisions are never easy to make...and I cant imagine myself being more senior and making more decisions....Need to build more experience and confidence.

He agreed that she was a croup patient. Decisions....don't like making them. But my job nature doesn't allow me to escape from this.
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