Croup

Question 1

A previously well 3-year-old girl is seen in the emergency department late one evening having woken from sleep with a barking cough and respiratory distress. On arrival to the emergency department she continues to have mild respiratory distress with stridor at rest.

Imp/DDx/Goals`

Answer 1

Impression:
Given age, barking cough, time of preesntation inspiratory stridor this is most likely a presentation of croup.
Want to rule out other life-threatening DDx including respiratory obstruction (anaphylaxis, FBO, epiglottitis), infection (bronchiolitis, pneumonia, bacterial tracheitis).

Goals:

• identify underlying aetiology
• utilise and ABDCE approach to assessment and concurrently initiate emergent and definitive treatments

Question 2

Croup - History

Answer 2

History

• sx: wheeze, cough, sputum, stridor, coryza (features of other respiratory presentation
• HxPC: infective, prodromal period, age,
• risk factors: phlegm, change in behaviours etc, sick contacts, preceding viral illness
• paediatric history (ADING)

Question 3

Croup - Examination

Answer 3

Examination
LEAVE child alone if suspected croup - do NOT want to agitate and make worse, otherwise, if tolerated;
- general observation + vital signs
- respiratory exam
- ENT exam

Question 4

Croup - Investigations

Answer 4

Investigations

• croup is largely clinical diagnosis
• depends on level of suspicion for dangerous differentials, but otherwise should be limited to prevent child agitation

Question 5

Croup - Management

Answer 5

Management:

• can be managed supportively at home
• indications for admission: (Severe airway obstruction, no improvement with adrenaline nebs, atypical presentation, significant risk factors, other condition) - if severe call paeds reg and escalate care

Supportive:

• fluids
• analgesia
• keep with carers to reduce stress, minimal intervention

Definitive:

• oral corticosteroids (prednisone 1mg/kg or dexamethasone 0.15mg/kg)
• consider administering adrenaline

Ongoing:

• keep to monitor for 2-4hrs post corticosteroid administration to observe
• if stridor free at rest AND post steroid administration can be discharged
• strong parent education for warning signs and when to return (safety-netting)