2.6 Croup

Question 1

Typical age range for croup?

Answer 1

6months to 2 years

Question 2

What is the typical pathogen in croup and what does it cause?

Answer 2

Parainfluenza virus

causes oedema of the larynx and URTI

Question 3

How quickly does croup tend to improve and what treatment does it respond well to?

Answer 3

typically improves in less than 48 hours

responds well to dexamethasone 150micrograms/kg

Question 4

What is the typical presentation of croup?

Answer 4

• seal like barking cough
• stridor
• work of breathing
• low grade fever
• hoarse voice

Question 5

Tips for croup at home?

Answer 5

Sit child up and comfort them during coughing spells.
Fluids and rest.
Stay of school and wash hands to stop spread.

Question 6

If croup was worsening what are the stepwise options?

Answer 6

- dexamethasone 150microgram/kg
(- repeat dex after 12 hours)
- oxygen
- nebulised budesonide
- nebulised adrenaline
- intubation and ventilation

Question 7

Croup is typically caused by parainfluenza, what are some other causes?
Old causes?

Answer 7

Common:

• parainfluenza
• influenza
• adenovirus
• RSV

Previously diphtheria could cause croup and epiglottis (vaccines might not happen in developing countries)

Question 8

What sign would you see on xray in croup?

Answer 8

AP will show subglottic narrowing, commonly called the ‘steeple sign’

(a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’)