C - Laryngotracheobronchitis (LTB) & Croup

Question 1

What is croup and what isit caused by? (2)

Answer 1

1. inflammation of the upper airway,
2. commonly caused para influenza viruses
3. others: adenovirus, or respiratory syncytial virus, or RSV.

Question 2

Risk factors of croup? (3)

Answer 2

1. 3 months - 6 years
2. most common in boys
3. family history of croup or recurrent croup.

Question 3

Pathology (1) -> clinical manifestations of croup (11)?

Answer 3

Pathology:
1. Infection causes inflammation, edema and mucus secretion -> narrowing of the upper airway

Clinical manifestations:
- When airway becomes significantly narrowed -> 1. hoarseness, a harsh high-pitched sound during inspiration = inspiratory stridor
2. distinctive seal-like barking cough & sore throat due to cough, inflammation & irritation
3. rhinorrhea/runny nose & cold syptoms

4. Nasal flaring & substernal, subcostal or intercostal retractions -> child works hard to breathe past the narrowed airway & muscle pain/myalgia = can occur due to immune system fighting off infection
5. Crying and agitation -> increased oxygen demand and further airway obstruction.
6. dehydration & poor appetite due to reluctance to drink fluids,
7. fever,
8. breathing through the mouth.

Signs of severe croup:
9. fatigue and inability to keep up with the needed respiratory effort causes:
10. diminished breath sounds, STRIDOR: high-pitched whistling during ascultation, hypoxia, and cyanosis.

11. Eventually, inadequate ventilation -> respiratory acidosis & respiratory failure.

Question 4

Treatment of coup? (5)

Answer 4

• airway management!!!
• depends on severity of symptoms

Commonly prescribed treatments:
1. bronchodilators like racemic epinephrine and albuterol
2. corticosteroid: dexamethasone to decrease inflammation
3. antipyretics: acetaminophen to reduce fever
4. humidified supplemental oxygen
5. in the case of respiratory impending failure, intubation and mechanical ventilation

Question 5

NOT IMPT JS READ
How does transmission of croup occur? (3)

Answer 5

1. spread through airborne respiratory droplets, saliva
2. physical contact with an infected person or contaminated surface.
3. droplets enter the body, initially infecting the nasal passages and pharynx -> spreading to the larynx, trachea and bronchi.

Question 6

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Diagnosis of croup? (3)

Answer 6

1. Client’s history and findings
2. Labs & radiology not indicated unless there is concern for other serious problems like pneumonia
3. Chest XRay if done: often reveal a steeple sign = inverted V shape resembling a church steeple seen below the vocal cords