Croup Flashcards
Define croup.
Progressive spread of inflammation down respiratory tract from larynx, to trachea + bronchi secondary to a viral infection.
Explain the aetiology/risk factors for croup.
Parainfluenza = most common
Other viruses can present similarly e.g. RSV, influenza, rhinoviruses.
How is acute epiglottitis different to croup?
Caused by Haemophilus influenzae
Toxic looking
No cough,
Drooling.
Sx develop over shorter period of time (hours).
How is inhalation of a foreign body different to croup?
Acute onset
Clear hx
How is anaphylaxis different to croup?
Known allergy
Urticaria
Wheals
How is tracheitis different to croup?
Toxic looking
Croupy cough
Higher fever
No drooling
Poor response to conventional therapy for croup inc. racemic epinephrine + systemic corticosteroids
Summarise the epidemiology of croup.
6m to 6y
Peak 2y
More common in Autumn
What are symptoms of croup?
1: Coryzal Sx +/- fever.
2: Barking cough (vocal cord impairment) + stridor (seal-like yelp) 1–2 days after cough.
Why should you not examine a child with suspected croup?
May cause bronchospasm.
Clinical dx.
What are the signs of croup?
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
What are the signs of epiglottitis?
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
What are the signs of tracheitis?
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
What are the signs of mild croup?
Occasional Barking cough
No audible stridor at rest
No/ mild suprasternal/ intercostal recession
Alert: happy to eat, drink, play
Pink
What are the signs of moderate croup?
Frequent Barking cough
Inspiratory stridor at rest
Suprasternal + sternal wall retraction at rest
No/ little distress/ agitation
Can be placated + is interested in surroundings
What are the signs of severe croup?
Frequent Barking cough
Marked inspiratory stridor (occasionally expiratory)
Severe chest retractions
Significant distress + agitation / lethargy / restlessness (hypoxaemia)
Tachycardia with more severe obstructive Sx + hypoxaemia
What are signs of imminent respiratory failure in croup?
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
If a CXR is performed in croup what may be seen? How does this differ from the lateral view in acute epiglottitis?
PA: subglottic narrowing = “Steeple sign”
Acute epiglottitis: swelling of epiglottis = “Thumb sign”
What is the management for croup?
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
What are possible complications for croup?
Lymphadenitis
Otitis Media
Bacterial superinfection (rare)
What is the proper name for croup?
Viral laryngotracheobronchitis
Give 3 differentials for croup
Laryngomalacia
Acute epiglottitis
Inhaled foreign body
In which 7 circumstances should a child be considered for admission with croup?
Chronic lung disease
Congenital heart disease (haemodynamically significant)
Neuromuscular disorders
< 3m
Immunocompromised
Inadequate fluid intake (50-75%)
Poor response to initial tx
When should immediate hospital admission for croup occur?
Moderate/severe croup or impending respiratory failure.
RR > 60
High fever
Toxic appearance
What should be administered if child with croup is too unwell for oral dexamethasone/ prednisolone?
Dexamethasone IM
Budesonide nebs
