Ah, the classic "stridor showdown!" This is a bread-and-butter topic for the UKMLA AKT. Distinguishing between Croup and Epiglottitis is literally a life-saving skill because while one usually needs a bit of steroid and cuddles, the other is a "don't-even-look-at-the-throat" surgical emergency.

Let's break down the differences first. I'll pull up a comparison table to make the clinical features clear.

That image gives a good overview of stridor, but let's get specific with a direct comparison table for Croup and Epiglottitis, as these are the two you'll most likely need to distinguish in an AKT scenario.

1. Severity Scoring: The Westley Croup Score

For Croup, we use the Westley Croup Score to decide on management. It looks at five factors:

1. Inspiratory Stridor (0-2 points)
2. Intercostal Recession (0-3 points)
3. Air Entry (0-2 points)
4. Cyanosis (0-5 points)
5. Level of Consciousness (0-5 points)

Score Interpretation:

• Mild (≤2): Occasional barking cough, no stridor at rest.
• Moderate (3–5): Frequent barking cough, easily audible stridor at rest, suprasternal/intercostal recession.
• Severe (≥6): Prominent inspiratory stridor, marked recession, agitation/distress.

2. Treatment Guidelines

Croup Management (NICE/UK Guidelines)

• All children: A single dose of oral Dexamethasone (0.15 mg/kg) is now recommended for all children with croup, regardless of severity.
• Moderate/Severe: Hospital admission.
• Emergency (Severe/Life-threatening): Nebulised Adrenaline (5ml of 1:1000) and high-flow oxygen.

Epiglottitis Management

• DO NOT EXAMINE THE THROAT: This can trigger total airway obstruction.
• Senior Help: Call for the "A-team" (Senior Anaesthetist, ENT Surgeon, and Paediatrician) immediately.
• Airway: Secure the airway in theatre (intubation or tracheostomy if needed).
• Antibiotics: IV Ceftriaxone (to cover H. influenzae).

I'll pull up a flowchart for the management of acute stridor to help you visualize the decision-making process.

That flowchart was a bit too specific to post-extubation, so I've put together a more relevant management pathway for you here. This covers the "what do I do now?" part of your AKT prep.

This flowchart should help you keep the management steps straight. Remember, for the AKT, the "toxic" appearance and drooling are the biggest red flags for Epiglottitis, while the "barking cough" is the classic hallmark of Croup.

One high-yield tip: Bacterial Tracheitis is another differential to keep in the back of your mind. It looks like Croup but doesn't respond to steroids/adrenaline and the child is much more unwell (toxic).

Would you like to try a few flashcards to lock in these differences, or maybe a quick quiz to see how this looks in an exam format?