1 - Paeds - Resp - Croup

Question 1

long name?

Answer 1

laryngotracheobronchitis

Question 2

what actually happens? - what is potentially dangerous in young kids?

Answer 2

airways - mucosal inflam and inc secretions, oedema of subglottic area potentially dangerous in young children -> tracheal narrowing

Question 3

viral croup is what % of laryngotracheal infections? commonest pathogen? others? (3)

Answer 3

95%
parainfluenza
RSV, influenza, human metapneumovirus

Question 4

occurs at what age? peak incidence? when in year? why might it be recurrent?

Answer 4

6m-6y
peak - 1-2y
in autumn
may be recurrent due to atopy

Question 5

clinical features of croup

when might stridor and chest recession disappear

Answer 5

barking cough
harsh stridor
hoarseness

Sx start/worse at night

if only mild upper airway obstruction and at rest

Question 6

decision to admit is based on…

Answer 6

severity, time of day, access to hospital, age (low threshold if <12m), parental understanding and confidence in managing it,

Question 7

treatment of croup if mild obstruction

Answer 7

manage at home ideally and observe closely for worsening

inhalation of humid air, oral dex, oral pred, and neb budesonide —»» reduce severity/duration/need to admit

Question 8

sever obstruction treatment? what is very important to get? rarely do what?

Answer 8

neb adrenaline with 02 gives transient improvement

close monitoring and advice from anaesthetist / ICU is imperative - due to risk of rebound Sx once adrenaline wears off ~2h

rarely do tracheal intubation