Croup Flashcards
Which virus most commonly causes croup?
Parainfluenza virus
Type 1 most common
Type 2 in outbreaks (milder)
Type 3 seasonally (more severe)
What is the management of mild croup?
Single dose of dexamethasone (oral)
- 150 micrograms/kg for 1 dose
Mild croup = occasional barking cough, no stridor at rest, mild or no respiratory distress
What is the management of moderate or severe croup in a child who is able to take oral medication? (4)
Dexamethasone
- Oral: Initially 150 micrograms/kg for 1 dose (given before transfer to hospital)
- Prednisolone can also be given prior to transfer to hospital in severe croup (Oral, 1-2 mg/kg) - Oral or IV injection: 150 micrograms/kg in hospital
- Oral or IV injection: 150 micrograms/ks after 12 hours (if required)
- If required in hospital: nebulised adrenaline/epinephrine solution 1 in 1000 (1mg/mL)
If unable to receive oral medication while awaiting transfer to hospital: dexamethasone (IM injection) or budesonide (by nebulisation)
Severe croup: frequent barking cough, stridor at rest, significant distress/agitation
A child arrives to the GP with severe croup and is too unwell to receive oral medication, what are two suitable alternatives for treatment while awaiting hospital admission?
- Dexamethasone (IM injection)
- 150 micrograms/kg - Budesonide (by nebulisation)
Which children who present with mild croup, should be treated the same as children with severe croup? (4)
- Chronic lung disease
- Immunodeficiency
- Impending respiratory failure
- Children aged under 3 months
What can be given to children with severe croup that is NOT effectively controlled with corticosteroid treatment?
Nebulised adrenaline/epinephrine solution in 1 in 1000 (1 mg/mL)
The clinical effects last at least 1 hour, but usually subside 2 hours after administration - need to monitor the child carefully for recurrence of severe respiratory distress
What dose of dexamethasone should be given to all children who present with croup?
150 micrograms/kg
What is the preferred route of administration of dexamethasone in children with croup in the GP setting?
Oral
If too unwell to receive oral medication: dexamethasone (IM injection) or bedesonide (by nebulisation) are alternatives while waiting hospital admission. If in hospital dexamethasone can be given by IV injection
For severe croup that is not effectively controlled with corticosteroid treatment, what is the dose of nebulised adrenaline/epinephrine solution?
1 in 1000 (1 mg/mL)
If a child is given nebulised adrenaline/epinephrine solution for severe croup, how long do the clinical effects last?
At least 1 hour, but usually subside 2 hours after administration
The child needs to be monitored carefully for recurrence of severe respiratory distress
Croup is characterised by which 3 symptoms?
Coryzal symptoms Barking cough (worse at night) Respiratory stridor
OTHER:
- Fever
- Hoarse voice
- Respiratory distress
What are signs of respiratory distress? (8)
- Tachypnoea
- Grunting
- Nassal flaring
- Tracheal tug
- Retractions: suprasternal, subcostal, intercostal
- Agitation
- Mood changes
- Cyanosis
If an X-ray is done for croup (not needed for diagnosis), what would sign is seen?
Steeple sign
- a posterior-anterior view will show subglottic narrowing
How would a child with mild croup present? (4)
- Occasional barking cough
- No audible stridor at rest
- No or mild suprasternal and/or intercostal recession
- The child is happy and is prepared to eat, drink, and play
How would a child with moderate croup present? (5)
- Frequent barking cough
- Easily audible stridor at rest
- Suprasternal and sternal wall retraction at rest
- No or little distress or agitation
- The child can be placated and is interested in its surroundings
