• stridor
• Down’s syndrome

A 36 year old woman with Down’s syndrome and hypothyroidism presented to the emergency department with breathlessness. She had suffered with coryzal symptoms for a week, before becoming increasingly dyspnoeic the day before presentation. On arrival she was unable to speak and stridulous. She was neither drooling nor toxic. Her temperature was 37.4°C. However oxygen saturation was reduced and arterial blood gas measurement showed a type 2 respiratory failure with acidosis. An urgent anaesthetic opinion was sought, and the patient transferred to the resuscitation room. Fibreoptic laryngoscopy confirmed the suspicion of a supraglottitis. After inhalation induction using sevofluorane, intubation was achieved with difficulty. …