Croup Flashcards

1
Q

Define croup.

A

Progressive spread of inflammation down respiratory tract from larynx, to trachea + bronchi secondary to a viral infection.

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2
Q

Explain the aetiology/risk factors for croup.

A

Parainfluenza = most common

Other viruses can present similarly e.g. RSV, influenza, rhinoviruses.

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3
Q

How is acute epiglottitis different to croup?

A

Caused by Haemophilus influenzae

Toxic looking

No cough,

Drooling.

Sx develop over shorter period of time (hours).

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4
Q

How is inhalation of a foreign body different to croup?

A

Acute onset

Clear hx

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5
Q

How is anaphylaxis different to croup?

A

Known allergy

Urticaria

Wheals

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6
Q

How is tracheitis different to croup?

A

Toxic looking

Croupy cough

Higher fever

No drooling

Poor response to conventional therapy for croup inc. racemic epinephrine + systemic corticosteroids

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7
Q

Summarise the epidemiology of croup.

A

6m to 6y

Peak 2y

More common in Autumn

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8
Q

What are symptoms of croup?

A

1: Coryzal Sx +/- fever.
2: Barking cough (vocal cord impairment) + stridor (seal-like yelp) 1–2 days after cough.

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9
Q

Why should you not examine a child with suspected croup?

A

May cause bronchospasm.

Clinical dx.

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10
Q

What are the signs of croup?

A

Incidence: Common
Age: 6 months - 3 years
Aetiology: Viral
Speed of onset: Slow
Fever: Rare >39 degrees
Cough: Barking
Voice: Hoarse
Position: Supine
Neck X-Ray AP: Steeple sign
Neck X-Ray Lateral: Normal
Response to adrenaline: Very good

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11
Q

What are the signs of epiglottitis?

A

Incidence: Rare
Age: 2-7 years
Aetiology: Bacterial
Speed of onset: Very rapid
Fever: Normally >39 degrees
Cough: Suppressed
Voice: Muffled
Position: Sitting forward, neck extended
Neck X-Ray AP: Normal
Neck X-Ray Lateral: Thumb print
Response to adrenaline: No response

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12
Q

What are the signs of tracheitis?

A

Incidence: Rare
Age: 6 months - 14 years
Aetiology: Bacterial
Speed of onset: Rapid
Fever: Normally >39 degrees
Cough: Present
Voice: Hoarse
Position: Supine
Neck X-Ray AP: Steeple sign
Neck X-Ray Lateral: Hazy
Response to adrenaline: Partial or no response

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13
Q

What are the signs of mild croup?

A

Occasional Barking cough
No audible stridor at rest
No/ mild suprasternal/ intercostal recession
Alert: happy to eat, drink, play
Pink

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14
Q

What are the signs of moderate croup?

A

Frequent Barking cough

Inspiratory stridor at rest

Suprasternal + sternal wall retraction at rest

No/ little distress/ agitation

Can be placated + is interested in surroundings

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15
Q

What are the signs of severe croup?

A

Frequent Barking cough

Marked inspiratory stridor (occasionally expiratory)

Severe chest retractions

Significant distress + agitation / lethargy / restlessness (hypoxaemia)

Tachycardia with more severe obstructive Sx + hypoxaemia

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16
Q

What are signs of imminent respiratory failure in croup?

A

Barking cough (may be quiet or absent due to exhaustion)
Audible stridor at rest (may be soft)
Chest retractions (may be reduced)
Lethargy, listless, reduced level of consciousness
Pallor + cyanosis

17
Q

If a CXR is performed in croup what may be seen? How does this differ from the lateral view in acute epiglottitis?

A

PA: subglottic narrowing = “Steeple sign”

Acute epiglottitis: swelling of epiglottis = “Thumb sign”

18
Q

What is the management for croup?

A

All: Oral Dexamethasone: 0.15mg/kg (only sometimes in mild)

Mild: Supportive: anti-pyretics, encourage fluids

Moderate: Observe 3-4h

Severe: Admit + adrenaline nebs + O2

Impending respiratory failure: Consider intubation

19
Q

What are possible complications for croup?

A

Lymphadenitis

Otitis Media

Bacterial superinfection (rare)

20
Q

What is the proper name for croup?

A

Viral laryngotracheobronchitis

21
Q

Give 3 differentials for croup

A

Laryngomalacia

Acute epiglottitis

Inhaled foreign body

22
Q

In which 7 circumstances should a child be considered for admission with croup?

A

Chronic lung disease

Congenital heart disease (haemodynamically significant)

Neuromuscular disorders

< 3m

Immunocompromised

Inadequate fluid intake (50-75%)

Poor response to initial tx

23
Q

When should immediate hospital admission for croup occur?

A

Moderate/severe croup or impending respiratory failure.

RR > 60

High fever

Toxic appearance

24
Q

What should be administered if child with croup is too unwell for oral dexamethasone/ prednisolone?

A

Dexamethasone IM

Budesonide nebs