Croup Flashcards
What is Croup?
- Croup, also known as acute laryngotracheobronchitis is a common viral childhood illness
How does Croup present?
- BARKING COUGH
- Stridor
- Hoarseness of voice
- Fever
What age range does Croup typically affect?
- The children commonly affected are between 6months and 3 years
- The peak incidence is at 2 years of age
What is the pathophysiology of Croup?
- Croup is a viral upper respiratory tract infection which results in mucosal inflammation between the nose and the trachea
What are the causative organisms for croup?
- Parainfluenza Virus
- RSV (Respiratory Syncytial Virus)
- Adenovirus
-Rhinovirus
What are the risk factors for Croup?
- Male
- Autumn/spring season
What are the symptoms of Croup?
Symptoms:
- Typically a 1-4 day history of a non-specific cough, rhinorrhoea and fever
- Which then progresses to a barking cough and hoarseness
- Symptoms tend to be worse at night
- Fever
- Drowsiness and Lethargy (Red flags for resp failure)
What are the signs for Croup?
- Stridor
- Chest sounds are normal, but with severe airflow limitation the sounds can be decreased
- Resp Distress: tachypnoea and intercostal recession
- Red flag signs: cyanosis, low conscious levels, laboured breathing and tachycardia
What is the Westley Croup Score?
- The westley croup score is a scoring system that helps categorise children based on their presenting clinical features.
- It includes:
- Sp02 <92% (0= none, 4= when agitated, 5= at rest)
- Stridor (0=none, 1= when agitated, 2= at rest)
- Retractions (0=none, 1=mild, 2=moderate, 3=severe)
- Air entry (0=normal, 1=reduced, 2=markedly reduced)
- Consciousness (0= normal, 5=reduced)
- mild (0-2)
- moderate (3-5)
- severe (6-11)
- impending respiratory failure (12-17)
What are the Differential Diagnosis of Croup?
-Epiglottitis
-Inhaled foreign body
- Acute anaphylaxis
-Peritonsillar Abscess (quinsy)
-Retropharyngeal Abscess
-Laryngomalacia
What’s the difference between croup and epiglottis? Categories: Time course, Features prior, Cough, Feeding, Mouth, Toxic, Fever, Stridor, Voice?
- Time course: croup- days, epiglottitis- hours
- Features prior: croup- coryza, epiglottitis- none
- Cough: croup- barking, epiglottitis - slight if any
- Feeding: croup- can drink, epiglottis- no
- Mouth: croup- closed, epiglottis- drooling saliva
- Toxic: croup- no, epiglottis- yes
- Fever: croup- <38.5, epiglottis - >38.5
- Stridor: croup- rasping, epiglottitis- soft
- Voice: croup- hoarse, epiglottitis - weak or silent
What are the investigations that you would do for Croup?
- FBC, CRP, U&E
- CXR - To identify other symptoms such as a foreign body
- Direct/ Indirect laryngoscope isn’t performed unless the illness is atypical or another cause of airway obstruction is suspected
- Pulse Oximetry
When should croup be managed at hospital as an admission?
- Previous history of severe airway obstruction
- <6 months of age
- immunocompromised
- inadequate fluid intake
- poor response to initial treatment
- uncertain diagnosis
When should immediate hospital admission be considered?
- The child has moderate/severe croup and impending respiratory failure
- You suspect a serious disorder caused by infection - peritonsillar abscess, laryngeal diphtheria and a non-infectious cause ( foreign body )
What is the treatment for Croup ?
- single dose of oral dexamethasone / oral prednisolone
- nebulised adrenaline - temporary relief of symptoms
- ensure the child is as calm as possible as continuous crying causes increased oxygen demand and causes respiratory muscle fatigue
- oxygen therapy as required
- contact ENT and an anaesthetist for airway support
