Croup Flashcards
What is croup?
Croup is a form of upper respiratory tract infection seen in infants and toddlers.
Who does croup typically effect?
It typically affects children aged 6 months to 2 years
Where does croup cause oedema?
Larynx
What is the most common cause of croup?
Parainfluenza virus
What other viruses cause croup?
- Influenza
- Adenovirus
- Respiratory Syncytial Virus (RSV)
What time of year is croup most common in?
Autumn
What is diphtheria?
A bacterial infection of the nose and throat caused by Corynebacterium diphtheriae. The most common symptom is a thick grey coating on the throat and tonsils.
What time frame does croup usually improve?
48 hours
What are the symptoms of croup?
- Cough
- Stridor
- Fever
- Coryzal symptoms
- Increased work of breathing e.g. retraction
What is the cough in croup described as?
- Barking, seal-like
- Worse at night
Why should the throat not be examined in a child that has croup?
due to the risk of precipitating airway obstruction
What is defined as mild croup?
- Occasional barking cough
- No audible stridor at rest
- No or mild suprasternal and/or intercostal recession
- The child is happy and is prepared to eat, drink, and play
What is defined as moderate croup?
- Frequent barking cough
- Easily audible stridor at rest
- Suprasternal and sternal wall retraction at rest
- No or little distress or agitation
- The child can be placated and is interested in its surroundings
What is defined as severe croup?
- Frequent barking cough
- Prominent inspiratory (and occasionally, expiratory) stridor at rest
- Marked sternal wall retractions
- Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)
- Tachycardia occurs with more severe obstructive symptoms and hypoxaemia
When should a child with croup be admitted?
- Moderate or severe croup
- < 3 months of age
- known upper airway abnormalities
- Uncertainty about diagnosis
Nae 4 differential diagnoses for croup?
- Acute epiglottitis
- bacterial tracheitis
- Peritonsillar abscess
- Foreign body inhalation
What investigations are carried out for croup?
- most cases are diagnosed clinically
- sometimes chest X-ray
What is found on chest X-ray that would indicate croup?
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’
What drug is typically responded to well for management of croup?
dexamethasone
What does of dexamethasone is given?
CKS recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
What alternative drug is used of dexamethasone is used if dexamethasone is not available?
Prednisolone
How long should dexamethasone be repeated if required?
After 12 hours
What is the stepwise approach is used in severe croup?
- Oral dexamethasone
- Oxygen
- Nebulised budesonide
- Nebulised adrenalin
- Intubation and ventilation
