Croup Flashcards
Etiology
- Most commonly caused by parainfluenza virus 1 & 3
* Others: Influenza A and B, adenovirus, RSV, metapneumovirus
Symptoms
- Barking Cough
- Usually at night
- Inspiratory Stridor
- Hoarseness
- Fever
- Increased work of breathing
- Symptoms fluctuate with the calmness of the child
- Can be preceded by and URTI (cough, rhinorrhea, fever)
Clinical Course
3-7 days (60% have resolution of barking cough in 48 hrs)
Risk Factors
- 6 mo – 36 mo, occasionally up to 6 yrs
- Boys > Girls
- Autumn / Winter (Sept – Dec)
DDX
And DDX if <6 months
- Bacterial Tracheitis
- Epiglottitis
- Retropharyngeal / Parapharygeal / Peritonsillar Abscess
- Foreign Body
- Acute Allergic Reaction
<6 months think thracheomalacia
Specific Measurements
- HR - tachycardia
- RR – tachypnea
- SP02
- Weight
Physical Exam
- Work of breathing: accessory muscle use, indrawing suprasternal and / or intercostal
- Distress / agitation / lethargy
- Cyanosis
Investigations & findings
- Usually not needed
* XRAY – steepling (cone shaped narrowing instead of normal square subglottic area)
Treatment
• Make the child comfortable -> care not to distress / frighten the child during assessment / treatment
• Analgesics / Antipyretics -> not studied but to keep child comfortably
• Dexamethasone 0.6 mg / kg PO x 1 max 10 mg
o Improvement within 2-3 hrs and persists for 24-48 hrs
• Consider blow-by 02
New evidence that 0.15 m/kg likely equivalent if mild
• Nebulized Epinephrine in moderate to severe croup
o 5 mL 1:1000 L-epinephrine via neb over 15 min
**NOT humidified O2
Not SABA
Not abx.
How fast does the dex work
within 2 hours
A kid 2 years old comes in with croup. Very classic symptoms, barking cough, fever, stridor with activity. You weight him and you’re about to prescribe Dex when the mom asks if it’s bad that he’s gotten dex twice in once week. You ask why he had dex the first time and she said for this same thing. What do you do?
Don’t repeat the dex
Probably send to ED
Needs x-ray
