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Clinical Methods > Acute Viral Laryngotracheobronchitis (Croup) > Flashcards

Acute Viral Laryngotracheobronchitis (Croup) Flashcards

1
Q

What is Croup? (Acute Viral Laryngotracheobronchitis)

A

Common childhood infection of the upper airway, which obstructs breathing and causes a characteristic barking cough

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2
Q

Presentation of Croup?

A
  1. Sudden onset ‘seal-like’ barking cough
  2. Stridor (Inspiratory)
  3. Hoarse voice
  4. Respiratory distress
  5. May be a fever
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3
Q

Which age group is most commonly affected by Croup?

A

Children 6 months – 3 years, but can affect as young as 3 months

Peak incidence is at 2 years of age

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4
Q

Pathophysiology of Croup

A

Viral URTI results in mucosal inflammation at the supraglottic, glottic, and tracheal level causing airway narrowing and turbulent airflow

  • Characteristic barking cough is caused by the impaired movement of the vocal cords
  • Stridor is caused by turbulent airflow
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5
Q

What is the most common organism which causes Croup?

A

Parainfluenza virus

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6
Q

List 2 risk factors for Croup

A
  1. Male
  2. Age between 6 months and six years
  3. Previous intubation
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7
Q

In which season is Croup most prevelant?

A

Autumn and Spring

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8
Q

Describe the typical clinical features from history of Croup

Incl red flag signs for respiratory failure!

A
  1. Typically a 1-4 day history of non-specific cough, rhinorrhoea and fever, progressing to a barking cough and hoarseness
  2. Symptoms worst at night
  3. Fever

Red Flag signs

  • drowsiness
  • lethargy
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9
Q

Describe the typical clinical features from history of Croup

Incl red flag signs for respiratory failure!

A
  1. Stridor
  2. Chest sounds may be normal or decreased (in severe airflow limitation)
  3. If in respiratory distress: tachypnoea, intercostal recession
  4. Red flag signs:
  • cyanosis
  • lethargic/decreased level of consciousness
  • laboured breathing
  • tachycardia
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10
Q

What clinical scoring system is used to assess severity of Croup?

Describe the parameters of this

A

Westley Croup Score

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11
Q

Features of “Mild” Croup using the Westley Croup Score

A

Seal-like barking cough but NO stridor or sternal/intercostal recession at rest

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12
Q

Features of “Moderate” Croup using the Westley Croup Score

A

Seal-like barking cough with stridor and sternal recession at rest

No agitation or lethargy

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13
Q

Features of “Severe” Croup using the Westley Croup Score

A

Seal-like barking cough with stridor and sternal/intercostal recession

Associated with agitation or lethargy

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14
Q

Features of “Impending respiratory failure” Croup

A
  • ↑ upper airway obstruction
  • sternal/intercostal recession
  • asynchronous chest wall and abdominal movement
  • fatigue
  • pallor or cyanosis
  • ↓ level of consciousness or tachycardia

Degree of chest wall recession may diminish with the onset of respiratory failure as the child tires

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15
Q

In additon to clinical features, what RR is also indicative of severe respiratory distress?

A

RR of over 70 breaths/minute

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16
Q

List 4 DDx for Croup

A
  1. Epiglottitis
  2. Foreign body
  3. Retropharyngeal abscess
  4. Acute anaphylaxis
17
Q

List 2 URTIs in children which are/can be medical emergencies?

A

Acute Epiglottitis and very Severe Acute Croup

18
Q

List 2 Bacterial URT infections

A

Acute Epiglottitis and Retropharyngeal abscess

19
Q

Immediate management for Acute Epiglottitis?

A
  1. Leave the child with Mother. DO NOT Agitate the child
  2. Call for senior paediatrics AND Anaesthetics AND ENT
  3. May need to intubate
  4. May need a tracheostomy
  5. Once airway is secure then antibiotics and fluids can be given
20
Q

List 4 clear differences in presentation and history of Croup vs Epiglottitis

A

Acute Epiglottitis =

  • More systemically unwell → signs of sepsis
  • ↑ fever >39 - may not be responsive to antipyretics
  • Quieter, softer inspiratory stridor
  • Altered level of consciousness

(Above is same for Retropharyngeal abscess)

21
Q

Investigations for suspected Croup?

A

Mainly a clinical diagnosis

  1. FBC, CRP, U&Es
  2. Chest X-Ray to rule out ddx ie inhaled foreign bodies
  3. Pulse oximetry
  4. Risk scoring (if relevant)
22
Q

Advice to parents for home management of mild Croup?

A
  • paracetamol or ibuprofen can be used to control pain and fever
  • ensure child has adequate fluid intake
  • do NOT attempt to reduce fever by under-dressing child
  • check on child regularly, incl through the night

Advise parents that symptoms usually resolve within 48 hrs but can last upto a week and that croup is a viral illness so antibiotics are not needed

23
Q

Safety netting advice to parents for Croup

A

To seek urgent medical advice/ call an ambulance if symptoms worsen e.g.

  • continual stridor
  • difficulty breathing (skin between ribs is pulling in with every breath)
  • restless, agitated or upset
  • pale, blue, or grey in colour
  • cannot talk, drooling, trouble swallowing
24
Q

List 4 signs that a child with Croup is deteriorating?

A
  1. Louder OR Quieter stridor
  2. ↑or variable RR
  3. ↑ OR ↓ work of breathing
  4. ↑ abdominal breathing
  5. ↑ HR
  6. Altered level of consciousness, unable to settle, quieter than usual, reduced level of consciousness
25
Q

What should be given to ALL children with mild, moderate, or severe croup?

A

A single dose of oral dexamethasone (↓ inflam, opens airway)

If child is too unwell, single dose inhaled budesonide (nebulised) or IM dexamethasome are possible alternatives

26
Q

List 4 instances where we should consider admission for Croup

A
  1. RR > 60 breaths/minute or who have a high fever or ‘toxic’ appearance.
  2. chronic lung disease
  3. congenital heart disease
  4. NM disorders
  5. immunodeficiency
  6. age < 3 months
  7. inadequate fluid intake
  8. factors that might affect a carer’s ability to look after a child with croup
  9. longer distance to healthcare, in case of deterioration
27
Q

When should Immediate hospital admission occur for Croup?

A
  1. Moderate/severe croup or impending respiratory failure
  2. You suspect a serious disorder caused by infection e.g. peritonsillar abscess, laryngeal diphtheria, or a non-infectious cause (foreign body)
28
Q

???? Cant find this mentioned on NICE? Ask in workshop

A

Clinical Methods (21 decks)

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