6.2 Croup

Question 1

Croup Syndromes

Answer 1

Syndromes characterized by
- Hoarseness
- Barky cough
- Stridor
- Respiratory distress

Examples
- Laryngotracheobronchitis (LTB)
- Epiglottis

Question 2

Laryngotracheobronchitis (LTB)

Answer 2

• Most common form of croup
• Moderate to severe airway obstruction and inflammation
• Typically occurs in young children 6 months to 3 years
• Most commonly caused by viruses (flu, RSV)
• Starts out as a upper respiratory tract infection (URI) but then the infection descends lower which causes laryngeal symptoms
• HALLMARK IS INSPIRATORY STRIDOR

Other Symptoms
- Increased work of breathing
- Mild fever
- Hoarseness
- Mild fever
- Inspiratory stridor
- Barky cough

Question 3

LTB Management

Answer 3

Mild or Severe

Mild - Does not have stridor at rest (can be managed at home
Severe - Stridor at rest

Mild (Most Cases)
- Hydration is important but only fluids can only be given if respiratory rate is less than 60 (worried about aspiration)
- Cool mist humidifiers (constricts edematous blood vessels to help decrease inflammation) or going out on a cold night.
- Control fever (acetaminophen or Motrin)

Severe (Hospitalized)
- Oxygen Therapy
- Nebulized Racemic Epinephrine (anti-histamine that stimulates beta-2 receptors to relax bronchial smooth muscles to reduce airway resistance) - Helps airways open up.
- Systemic/Nebulized Corticosteroids (to constrict edematous blood vessels and relax bronchial smooth muscles)
- Pulse Oximetry
- THOROUGH ASSESSMENT OF IF STRIDOR DISSAPEARS AT REST

Question 4

Epiglottitis

Answer 4

• ALWAYS CONSIDERED A MEDICAL EMERGENCY
• Severe inflammation of epiglottis at the back of the throat
• Most commonly found in slightly older children 2-5 years old
• Caused by bacteria (Staph, Strep)

Symptoms
- VERY ABRUPT ONSET
- Sore throat
- Drooling (because airway is so constricted where saliva cannot be swallowed) - Dysphagia
- Protruding tongue
- Tripod position (leaning forward to increase lung expansion)
- Muffled voice
- Anxious appearance (agitation)
- Typically DO NOT HAVE COUGH

• DO NOT EXAMINE THROAT WITH TONGUE BLADE BECAUSE YOU CAN CAUSE FURTHER IRRITATION/INFLAMMATION CAUSING THROAT TO COMPLETELY CLOSE.
• HAVE EMERGENCY TRACHEOSTOMY KIT AT BEDSIDE INCASE AIRWAY CLOSES

Question 5

Epiglottitis Management

Answer 5

• Allow children to assume position of comfort (tripod position)
• Intubation and tracheostomy should be nearby incase airway closes
• Antibiotic therapy
• IV Steroids to decrease inflammation

Question 6

LTB VS EPIGLOTTITIS

Answer 6

LTB
- Sound worse then they look

Epiglottitis
- Look worse then they sound