Croup

Question 1

what is the causative organism?

Answer 1

parainfluenza virus

Question 2

age

Answer 2

6 months - 3 years

Question 3

features

Answer 3

stridor
barking cough (worse at night)
fever
coryzal symptoms

Question 4

admission

Answer 4

CKS suggest admitting any child with moderate or severe croup. Other features which should prompt admission include:
< 6 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)

Question 5

Ix

Answer 5

the vast majority of children are diagnosed clinically

however, if a chest x-ray is done:
a posterior-anterior view will show subglottic narrowing, commonly called the ‘steeple sign’
in contrast, a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’

Question 6

Mx

Answer 6

CKS recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
prednisolone is an alternative if dexamethasone is not available

Question 7

emergency mx

Answer 7

high-flow oxygen

nebulised adrenaline