The following document was written by Mr Vik Veer MBBS(lond) MRCS(eng) DoHNS(eng) in Dec 2007. You may use the information here for personal use but if you intend to publish or present it, you must clearly credit the author and
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On Call Guide to Stridor


Stertor – noisy breathing caused by partial obstruction of the respiratory tract above the level of the larynx. A bit like snoring, gurgling.

Stridor - noisy breathing caused by partial obstruction of the respiratory tract at or just below the level of the larynx.

Wheeze – noisy breathing caused by partial obstruction of small intra-thoracic airways. Like in asthma

It is sometimes quite difficult to differentiate between these three, so don’t get worry too much about it. Management of your patient is more important than carefully thought out definitions.


Some of these are actually stertor or wheeze – but you should try and keep everything in mind when treating these patients.




Whilst resuscitating, attempt to work out where the obstruction is:

A good history will also give clues:


Much of the management depends upon the pathology causing the stridor, but a reasonable treatment strategy would include:

  1. Oxygen – some give humidified oxygen although there isn’t any evidence for it.

  2. Adrenaline - 5mls of 1:1000 adrenaline nebulised

  3. Steroids
    • Dexamethosone 0.6mg/kg up to 8mg
    • or if not that bad – oral prednisolone 1mg/kg
    • or if not that bad – 2mg nebulised budesonide
    • Of course you can give combinations.

  4. Antibiotics – dependent on the cause but generally not a bad thing IV as long as they aren’t allergic to it.

  5. Consider Heliox as a holding measure. 30% oxygen and 70% helium – this mixture is easier to breath and can buy you a few more moments before surgery etc.

  6. Intubate – get an anaesthetist

  7. If they can’t secure the airway then proceed to a Needle Cricothyroidotomy and ask your anaesthetic team to start intermittent jet insufflation. Use a 12 gauge (brown) cannula and push it through the gap between the thyroid and the cricoid (first tracheal ring), at 45 degrees. Officially you only have 45minutes to get a proper airway, as there is inadequate ventilation of the lungs with this technique.

  8. If you still can’t get a secure airway you will need to move on to a tracheostomy.

Remember that you won’t ever be faced with something like this by yourself. There are loads of very experienced doctors in hospitals even at night. Call everybody and work as a team. Its amazing how your confidence springs back when your seniors and an anaesthetic team arrive! Just stay calm and think as clearly as you can. You’ll be fine!

Further Reading

eMedicine - Stridor - by Brian Benson MD


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