Croup

Question 1

Croup differentials

Answer 1

Acute epiglottitis

Bacterial tracheitis

Peritonsillar abscess

Foreign body inhalation

Question 2

Croup aetiologies

Answer 2

Parainfluenza

Influenza

Adenovirus

Respiratory syncytical virus (RSV)

Question 3

Clinical features of croup

Answer 3

Increasedwork of breathing

“Barking”cough, occurring in clusters of coughing episodes

Hoarse voice

Stridor

Low gradefever

Coryzal symptoms

Question 4

Croup pathiphysiology

Answer 4

Upper respiratory tract infection causing oedema in larynx

Question 5

CXR findings in croup

Answer 5

Posterior-anterior view will show subglottic narrowing, commonly called the ‘steeple sign’

Lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’

Question 6

Croup management

Answer 6

Admit any child with moderate or severe croup (or <6 months, known upper airway abnormalities or uncertainty about diagnosis)

Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity

Prednisoloneis an alternative if dexamethasone is not available

Question 7

Emergency management of croup

Answer 7

High-flow oxygen

Nebulised adrenaline