Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting context
Symptom narrative
Onset setting
Trigger exposure
Progression pattern
OPQRST
OPQRST applicability
Acute upper airway symptoms
Rapid change risk
Onset
Onset features
Sudden onset
Gradual onset
Time last normal
Provocation/Palliation
Modifiers
Positional change effect
Exertion effect
Eating or drinking effect
Response to bronchodilator
Quality
Symptom character
Stridor quality
Voice change
Barky cough
Region/Radiation
Symptom location
Throat localization
Chest localization
Neck pain
Severity
Severity indicators
Dyspnea at rest
Inability to speak full sentences
Inability to swallow secretions
Timing
Time course
Intermittent episodes
Constant symptoms
Nocturnal predominance
Associated symptoms
Associated symptom screen
Fever
Drooling
Dysphagia
Odynophagia
Urticaria
Facial or tongue swelling
Wheeze
Hemoptysis
Chest pain
Event specific history
Aspiration and foreign body
Choking episode
Witnessed ingestion
Sudden cough paroxysm
Allergy and anaphylaxis
New food exposure
Medication exposure
Insect sting
Infection and inflammation
URI prodrome
Sore throat
Neck stiffness
Trauma and instrumentation
Recent intubation
Neck trauma
Caustic ingestion
Special populations
Pediatrics focused history
Croup exposures
Vaccination status
Small object access
Pregnancy focused history
Gestational age
Recent reflux or aspiration risk
Immunocompromised focused history
Neutropenia risk
Recent chemotherapy
HIV status
Anticoagulated focused history
Anticoagulant type
Airway bleed concern
Alarm Features
Immediate airway threats
Cannot miss airway danger signs
Stridor at rest
Drooling
Tripod positioning
Muffled voice
Silent chest
Exhaustion
Cyanosis
Altered mental status
Vital sign danger thresholds
High risk physiology
SpO2 below 92 percent on room air
Rapidly rising oxygen requirement
Hypotension
Bradycardia
Severe tachycardia with poor perfusion
Exam based escalation triggers
High risk findings
Inability to handle secretions
Marked suprasternal retractions
Trismus
Neck swelling
Uvular deviation
High risk historical triggers
High risk mechanisms
Suspected epiglottitis
Suspected anaphylaxis
Suspected foreign body aspiration
Post extubation stridor
Time critical actions
Escalation logic
If impending failure, resuscitation bay
If stridor at rest with distress, airway team activation
If suspected epiglottitis, avoid agitation and prepare controlled airway
Medications
Medication reconciliation
Current medications
ACE inhibitor exposure
Beta blocker exposure
Inhaled therapies
Recent medications
New antibiotic exposure
New NSAID exposure
Recent sedation exposure
Allergy relevant agents
High risk medication classes
ACE inhibitor (angioedema risk)
ARB (angioedema risk)
NSAID (hypersensitivity risk)
Medication contraindication traps
Therapy interaction and contraindication prompts
Beta blocker and epinephrine response blunting
MAOI and sympathomimetic sensitivity
Pregnancy medication safety considerations
Diet
Recent ingestion exposures
Food and liquid context
Recent meal timing
High aspiration risk foods
Alcohol exposure
Allergy related intake
Potential allergens
Nuts
Shellfish
New foods
Hydration and swallowing
Intake tolerance
Unable to tolerate liquids
Reduced oral intake
Review of Systems
Airway and respiratory
Respiratory ROS
Stridor
Wheeze
Cough
Hemoptysis
Pleuritic chest pain
ENT and infectious
ENT ROS
Sore throat
Voice change
Drooling
Neck pain
Fever
Allergy and dermatologic
Allergy ROS
Urticaria
Pruritus
Facial swelling
Tongue swelling
Gastrointestinal
GI ROS
Vomiting
Reflux symptoms
Caustic ingestion concern
Neurologic
Neuro ROS
Syncope
Confusion
Seizure activity
Collateral History and Family History
Collateral source
Collateral reliability
Witness account
EMS report
Caregiver report
Family history
Relevant inherited conditions
Hereditary angioedema (D84.1)
Atopy and asthma history
Exposure history
Household and community exposures
Sick contacts
Daycare or school outbreaks
Risk Factors
Patient factors
Airway risk factors
History of difficult airway
Obesity
Obstructive sleep apnea (G47.33)
Known laryngeal disease
Allergy risk factors
Prior anaphylaxis
Known food allergy
Mast cell disorder
Exposure and environment
Exposure risks
Smoke inhalation
Chemical irritants
Caustic ingestion
Procedure and device related
Iatrogenic risks
Recent intubation
Recent neck surgery
Recent endoscopy
Infectious risks
Infection risk factors
Unimmunized status
Immunosuppression
Diabetes mellitus (E11.9)
Differential Diagnosis
Life threatening
Life threatening causes
Anaphylaxis (T78.2)
Urticaria
Hypotension
Wheeze
Angioedema (T78.3)
Lip or tongue swelling
ACE inhibitor exposure
Epiglottitis (J05.1)
Drooling
Toxic appearance
Tripod
Bacterial tracheitis (J04.10)
High fever
Toxic appearance
Thick secretions
Foreign body airway obstruction (T17)
Sudden onset choking
Unilateral wheeze
Retropharyngeal abscess (J39.0)
Neck stiffness
Limited neck extension
Peritonsillar abscess (J36)
Trismus
Uvular deviation
Smoke inhalation injury (T59.81)
Soot in airway
Facial burns
Common
Common causes
Viral croup (J05.0)
Barky cough
Worse at night
Asthma exacerbation (J45.901)
Expiratory wheeze
Response to bronchodilator
Laryngospasm
Triggered by reflux
Triggered by irritant
Post extubation laryngeal edema
Recent intubation
Inspiratory stridor
Less common
Less common causes
Vocal cord dysfunction
Inspiratory symptoms
Normal oxygenation between episodes
Laryngeal tumor (C32)
Progressive hoarseness
Weight loss
Subglottic stenosis
Prior intubation history
Chronic stridor
Hereditary angioedema (D84.1)
No urticaria
Recurrent episodes
Mimics and pitfalls
Key mimics
Anxiety or panic symptoms
Paresthesias
Normal lung exam
Heart failure with wheeze
Crackles
Edema
Upper airway sounds transmitted from nasal obstruction
Improved after suction
Mild work of breathing
Past Medical History
Relevant prior diagnoses
Prior airway conditions
Asthma (J45)
Prior croup episodes
Prior epiglottitis
Allergy history
Food allergy
Medication allergy
Prior anaphylaxis
Prior procedures and events
Airway and ENT history
Prior intubation
Tracheostomy history
ENT surgery history
Baseline function
Baseline respiratory status
Home oxygen use
Baseline exercise tolerance
Physical Exam
General and vital signs
First look
Toxic appearance
Ability to speak
Position of comfort
Vital sign interpretation
Fever pattern
Tachypnea pattern
Hypoxia severity
Airway and ENT
Upper airway exam
Voice quality
Drooling
Trismus
Oropharynx edema
Uvular deviation
Neck exam
Tenderness
Swelling
Crepitus
Respiratory
Work of breathing
Nasal flaring
Suprasternal retractions
Intercostal retractions
Auscultation
Stridor location
Wheeze
Crackles
Silent chest
Cardiovascular
Perfusion assessment
Capillary refill
Skin temperature
Peripheral pulses
Skin
Allergy and perfusion signs
Urticaria
Angioedema distribution
Cyanosis
Neurologic
Mental status
Agitation
Somnolence
GCS trend
Pitfalls and subtle findings
High risk subtleties
Stridor decreasing due to fatigue
Tachycardia resolving with decompensation
Lab Studies
Core labs by scenario
Laboratory evaluation framework
No routine labs for mild uncomplicated croup
Targeted labs for toxic appearance
CBC
Suspected bacterial tracheitis
Suspected deep neck space infection
Basic metabolic panel
Significant respiratory distress
Pre intubation baseline
Point of care testing
Bedside tests
Glucose
Venous blood gas for impending failure
Gas interpretation
Gas pearls
Rising CO2 indicates fatigue
Normal CO2 does not exclude impending failure
Allergy and angioedema specific
Complement studies
C4 level for suspected hereditary angioedema
C1 inhibitor level and function for suspected hereditary angioedema
Limitations and pitfalls
Testing cautions
Swabbing and agitation risk in epiglottitis concern
Labs should not delay airway stabilization
Imaging
Scoring Systems
Clinical severity tools
Westley croup score
Use for croup severity tracking
Not a substitute for airway judgment
MRI
MRI role
Deep neck infection complication evaluation when stable
Radiation sparing alternative when time allows
CT
CT role
CT neck with IV contrast for suspected deep neck space infection
CT chest for suspected airway foreign body complications when stable
CT cautions
Transport risk in unstable airway
Contrast risk local protocol dependent
Ultrasound
POCUS applications
Soft tissue neck ultrasound for abscess localization
Lung ultrasound adjunct for lower airway pathology
Ultrasound limitations
Operator dependence
Limited visualization of deep retropharyngeal space
Special Tests
Bedside airway assessment
Bedside tests
Continuous pulse oximetry trend
Capnography trend if on oxygen support
Flexible nasolaryngoscopy
Laryngoscopy considerations
ENT controlled evaluation for stable patient
Avoid in unstable epiglottitis concern without airway plan
Foreign body evaluation
Airway foreign body testing
Inspiratory and expiratory chest radiographs
Decubitus radiographs in young children when available
Allergy evaluation
Anaphylaxis assessment aids
Serum tryptase timing limited utility
Not required for ED diagnosis
ECG
Indications
ECG context
Hypoxia with chest pain
Anaphylaxis with hypotension
High risk patterns
ECG red flags
Ischemic changes
Dysrhythmia contributing to dyspnea
Serial logic
Repeat ECG triggers
Ongoing chest discomfort
Persistent hypotension despite therapy
Assessment
Problem representation
Working syndrome classification
Upper airway obstruction likely
Lower airway process likely
Mixed process possible
Severity stratification
Airway severity
Stable without distress
Distress with preserved mentation
Impending failure
Key complications to rule out
Complication screen
Hypoxic injury risk
Aspiration pneumonitis
Airway edema progression
Diagnostic uncertainty
Alternative diagnoses
Foreign body despite normal radiograph
Angioedema without urticaria
Plan
First 5 minutes stabilization
Immediate priorities
Minimal agitation strategy
Upright positioning
Continuous monitoring
Two large bore IV if moderate to severe distress
Oxygen and ventilation
Blow by oxygen for children
Non rebreather for older children and adults
High flow nasal cannula if worsening distress and tolerated
Airway escalation triggers
If persistent stridor at rest with hypoxia, airway team activation
If decreasing mental status, prepare for controlled intubation
Medication pathways
Croup suspected
Dexamethasone PO or IM 0.6 mg per kg
Maximum 10 mg
Nebulized epinephrine racemic 2.25 percent 0.5 mL in 3 mL saline
Alternative L epinephrine 1 mg per mL 5 mL nebulized
Anaphylaxis suspected
Epinephrine IM 0.3 mg to 0.5 mg of 1 mg per mL adult
Repeat every 5 to 15 minutes if needed
Epinephrine IM 0.01 mg per kg pediatric
Maximum 0.3 mg prepubertal
Maximum 0.5 mg adolescent
Diphenhydramine IV or PO 25 mg to 50 mg adult
Cetirizine PO 10 mg adult if able to swallow
Methylprednisolone IV 125 mg adult
Albuterol nebulized for bronchospasm
IV crystalloid bolus 20 mL per kg pediatric
IV crystalloid bolus 1 L adult
Angioedema suspected
Histamine mediated pathway if urticaria present
Epinephrine IM dosing per anaphylaxis pathway
H1 antihistamine dosing per anaphylaxis pathway
Steroid dosing per anaphylaxis pathway
Bradykinin mediated angioedema local protocol dependent therapies
Early airway planning if tongue or floor of mouth swelling
Post extubation stridor suspected
Nebulized epinephrine as above
Dexamethasone IV 10 mg adult
Pediatric dexamethasone 0.6 mg per kg
Airway procedures
Airway plan
Difficult airway setup
Backup plan
Surgical airway readiness if cannot intubate cannot oxygenate
Intubation approach
Prefer experienced operator
Video laryngoscopy first line when available
Smallest appropriate endotracheal tube if subglottic edema
Induction and paralysis examples
Ketamine IV 1 mg per kg to 2 mg per kg
Etomidate IV 0.3 mg per kg
Rocuronium IV 1.2 mg per kg
Succinylcholine IV 1.5 mg per kg if no contraindication
Consultations
Specialty engagement
Anesthesiology for difficult airway
ENT for suspected epiglottitis and deep neck infection
ICU early for high risk airway
Reassessment loop
Reassessment cadence
Every 5 to 10 minutes until stable
After each intervention
Reassessment targets
Work of breathing trend
Stridor at rest trend
SpO2 trend
Mental status trend
Disposition
ICU criteria
ICU indications
Impending respiratory failure
Need for advanced oxygen support
Recurrent nebulized epinephrine with relapse
Suspected epiglottitis
Inpatient admission criteria
Admission indications
Persistent stridor at rest after therapy
Need for frequent treatments
Inadequate oral intake with dehydration
Observation pathway criteria
Observation candidates
Improved after nebulized epinephrine
Stable for monitoring period
Discharge criteria
Discharge requirements
No stridor at rest
Minimal work of breathing
Tolerating oral intake
Reliable caregiver and return access
Follow up timing
Follow up plan
Primary care within 24 to 72 hours for croup or mild obstruction
Allergy follow up for anaphylaxis or suspected trigger
Discharge Instructions
Copy discharge instructions
Summary
You were seen for noisy breathing called stridor and possible upper airway swelling
Your breathing improved and you are safe to go home now based on your exam
Medications
Take the steroid as prescribed if given
If you were prescribed an epinephrine auto injector, carry it with you at all times
Activity
Avoid known triggers if identified
Keep calm and avoid heavy exertion until fully better
Follow up
Follow up with your doctor in 1 to 3 days
If allergy related, follow up with an allergy specialist as arranged
Return to ED immediately for
Trouble breathing
Noisy breathing at rest
Blue lips or face
Drooling or inability to swallow
Severe swelling of lips or tongue
Fainting
Chest pain
Symptoms returning after epinephrine
References
Guidelines and key sources
Reference set
American Academy of Pediatrics clinical guidance on croup and upper airway obstruction 2017
World Allergy Organization anaphylaxis guidance update 2020
AAAAI and ACAAI anaphylaxis practice parameter update 2020
Infectious Diseases Society guidance for deep neck space infections local protocol dependent
Difficult Airway Society guidelines for tracheal intubation in critically ill adults 2018
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.