21. Croup

Question 1

Croup affects what age group ?

Answer 1

• Affects 6 mo-3 yo

Question 2

How long does sx last : Croup

Answer 2

• Symptoms last 3-7 days

Question 3

What virus : Croup (2)

Answer 3

• Parainfluenza Type 1 and 3

Question 4

Describe sx : Croup (5)

Answer 4

• Barky cough
• Stridor
• In-drawing suprasternal/intercostal
• Distress, agitation, lethargy
• Cyanosis

Question 5

Name DDX : Croup (5)

Answer 5

• Trachéite bactérienne
• Abcès rétro/parapharyngé/périamygdalien
• Epiglottitis
• Aspiration or ingestion of foreign body
• Allergic reaction (anaphyaxis or angioneurotic eddema)

Question 6

Describe sx : Bacterial tracheitis (5)

Answer 6

• 1-3d of URTI symptoms before worsening
• stridor
• dyspnea
• high fever
• toxic
• poor response to nebulized epinephrine and steroids

Question 7

Describe prise en charge : Bacterial tracheitis (5)

Answer 7

• Neck XR (lateral or AP) - Steeple sign as seen in Croup
• Endoscopy to confirm diagnosis and remove pseudomembranous exudates
• Airway, O2
• IV antibiotics to cover S aureus, GAS, S pneumo, H influenzae, M catarrhalis (Ceftriaxone or Cefotaxime +/- MRSA coverage)
• ICU

Question 8

Describe sx : Retro/parapharyngeal/peritonsillar abscess (6)

Answer 8

• High fever
• Neck pain
• Torticollis
• Drooling
• Respiratory distress
• Stridor

Question 9

Describe prise en charge : Retro/parapharyngeal/peritonsillar abscess (5)

Answer 9

• Neck XR (lateral) - bulging posterior pharynx (abnormal if >7mm at C2, >14mm at C6)
• CT ideally
• Intubation
• Consider incision and drainage
• IV antibiotics

Question 10

Name sx : Epiglottitis (5)

Answer 10

• Absence of barky cough
• fever
• drooling
• toxic
• sitting forward in “sniffing” position

Question 11

Name prise en charge : Epiglottitis (6)

Answer 11

• Neck XR (lateral) - thumb sign
• Direct laryngoscopy in OR
• Intubation (ideally in OR)
• IV corticosteroids
• IV antibiotics (Ceftriaxone or Cefotaxime +/- MRSA coverage)
• Supportive care, ICU

Question 12

Name sx : Aspiration or ingestion of foreign body (6)

Answer 12

• Croup cough
• choking episode
• wheezy
• hoarseness
• biphasic stridor
• decreased air entry

Question 13

Describe sx : Allergic reaction (anaphyaxis or angioneurotic eddema) (3)

Answer 13

• Rapid onset
• wheezing, stridor
• urticarial rash

Question 14

Describe tx : Croup (3)

Answer 14

• Dexamethasone 0.6mg/kg PO or IM (max 10mg) x 1
• If moderate-severe = Nebulized epinephrine over 15 minutes (Racemic 0.5mL or L-epinephrine 5mL of 1:1000)
• No evidence for Heliox (or helium-oxygen mixture), antibiotics, short-acting beta-2-agonist bronchodilators

Question 15

What’s the onset and how long does it act : Dexamethasone (2)

Answer 15

• Onset 2h
• acts 24-48h

Question 16

Can discharge croup when ?

Answer 16

after observing up to 4h if given epinephrine and dexamethasone

Question 17

Name Usual return to care instructions for croup (5)

Answer 17

• Fever persists x 48h
• fluid intake/output inadequate
• fatigue/lethargy
• fearful symptoms (resp distress, unable to talk, drools)
• does not improve after 3-4d