Croup Flashcards
What is croup?
A form of upper respiratory tract infection seen in infants and toddlers, characterised by stridor caused by laryngeal oedema and secretions
Parainfluenza viruses account for the majority of cases.
What is the peak incidence age for croup?
6 months to 3 years
During which season is croup more common?
Autumn
What type of cough is associated with croup?
Barking, seal-like cough
When does the cough associated with croup typically worsen?
At night
What symptoms should not be examined due to the risk of airway obstruction?
The throat
List common features of croup.
- Cough
- Barking, seal-like
- Stridor
- Fever
- Coryzal symptoms
- Increased work of breathing
What are the three severity grades of croup?
- Mild
- Moderate
- Severe
Describe the features of mild croup.
- Occasional barking cough
- No audible stridor at rest
- No or mild suprasternal and/or intercostal recession
- Child is happy and prepared to eat, drink, and play
Describe the features of moderate croup.
- Frequent barking cough
- Easily audible stridor at rest
- Suprasternal and sternal wall retraction at rest
- No or little distress or agitation
- Child can be placated and is interested in surroundings
Describe the features of 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
- Tachycardia occurs with more severe obstructive symptoms and hypoxaemia
According to NICE, which children should be admitted for croup?
- Moderate or severe croup
- < 3 months of age
- Known upper airway abnormalities
- Uncertainty about diagnosis
What are some important differential diagnoses for croup?
- Acute epiglottitis
- Bacterial tracheitis
- Peritonsillar abscess
- Foreign body inhalation
How are most cases of croup diagnosed?
Clinically
What will a posterior-anterior chest x-ray show in cases of croup?
Subglottic narrowing, commonly called the ‘steeple sign’
What will a lateral view in acute epiglottitis show?
Swelling of the epiglottis, known as the ‘thumb sign’
What is the recommended management for all children with croup?
A single dose of oral dexamethasone (0.15mg/kg)
What is an alternative to dexamethasone if it is not available?
Prednisolone
What are the emergency treatments for severe croup?
- High-flow oxygen
- Nebulised adrenaline
