Croup

Question 1

What is croup?

Answer 1

Laryngotracheobronchitis

Viral infection affecting upper respiratory tract

Question 2

When is croup most common?

Answer 2

Winter

Question 3

What causes croup?

Answer 3

Caused by parainfluenza virus or respiratory syncytial virus (RSV)

Question 4

What part of the resp. system is affected in croup?

Answer 4

Upper resp

Question 5

Explain the pathophys behind croup?

Answer 5

Infection in upper resp. tract = inflammation in mucosa of larynx

Get airway narrowing = obstruction = audible stridor

Small changes in radius = large change in airway resistance = more work to breath

• Symptoms worsen when child is agitated etc - more pressure in airways

Question 6

What increases the risk of developing croup?

Answer 6

Age - occurs in babies 6-36 months

Family history

Male

Congenital airway narrowing

Question 7

What are the presentations of croup?

Answer 7

Inspiratory stridor

Barking cough

Hoarse voice

Fever

Upper respiratory tract infections - nasal congestion and discharge

Question 8

How would you assess that someone has croup?

Answer 8

• minimal handling of baby - avoid causing distress
• ABCDE assessment
• Will see that child has: intercostal and sternal recession - due to use of accessory muscles
• Lethargy and agitation - in severe croup
• Use Wesley’s croup score to assess:
  1. Mild - no stridor at rest
  2. Moderate - moderate stridor at rest
  3. Severe - significant stridor at rest
  4. Impending respiratory failure - reduced consciousness, fatigue, absent respiratory sounds, tachycardia and cyanosis

Question 9

How is croup diagnosed?

Answer 9

• Clinical diagnosis - can do investigations to rule out DDx:

1. Lateral airway X-ray - rules out foreign body inhalation
2. Chest X-ray - tracheal/ subglottic narrowing = steeple sign