Croup Flashcards
Define croup
Acute laryngotracheobronchitis
Upper RTI -> commonly viral
Characterised by barking cough, hoarse voice and inspiratory stridor.
What is the key epidemiology of croup?
Commonly affects children from 6 months to 3 years.
Peak 2 years
Uncommon after age 6yrs.
More common in autumn/winter linked to parainfluenza virus.
What is the most common cause of croup?
Parainfluenza virus
Also - adenovirus, RSV, rhinovirus and influenza.
Bacteria rare = mycoplasma pneumoniae
Infection -> inflammation of subglottic and laryngeal mucosa causes partial obstruction of the airways leading to respiratory distress and stridor.
What are the typical symptoms of croup?
Coryzal symptoms, fever and non specific lasts 12-72hrs
Characteristic - harsh barking cough, hoarse voice, cry and inspiratory stridor
Severe - drowsy, lethargic or agitated
Usually resolved within 48hrs to a week.
What red flags need to be ruled out for croup?
Resp failure - signs of resp distress
Cyanosis
Decreased consciousness
Stridor - worsening obstruction
Decreased air entry on ausculation
Tachycardia
What investigations should be done for croup?
Diagnosis is clinical - consider investigatiosn carefully as distressing child may worsen symptoms
Pulse oximetry - for supplementary O2
CXR - different diagnosis, croup may show a steeple sign where the trachea is seen to taper.
What are the features of mild croup?
Seal-like barking cough but no stridor or sternal/intercostal recession at rest
What are the key features of moderate croup?
Seal-like barking cough with stridor and sternal recession at rest
No or little agitation/lethargy
What are the features of severe croup?
Seal-like barking cough
Stridor
Sternal/intercostal recession
Agitation or lethargy.
What are the signs of impending resp failure in croup?
Minimal barking cough
Stridor - harder to hear
Inc upper airway obstruction
Sternal/intercostal recession
Asynchronus chest wall and abdo movement
Fatigue/pallor or cyanosis
Decreased consciousness
Tachycardia
RR of over 70bpm
What is the typical treatment for mild croup?
No stridor or chest wall recessions may be treated at home.
Oral dexamethasone (0.15mg/kg)
Safety netting
Regular checks and fluid intake
Paracetamol or ibuprofen for fever and pain.
When should children with croup be considered for hospital admission?
Stridor/sternal recession at rest
High fever
Resp rate >60
Cyanosis
Lethargy or agitation
Fluid intake <75% normal or no wet nappies for 12 hours
Aged under 3 months
Chronic immunodeficiency. lung disease or neuromuscular disorders
What treatment can be used for croup in hospitals?
Supplementar oxygen if low sats
Steroids for all - oral dex or nebulised budesonide
Nebulised adrenaline for temporary symptom relief
Anaesthetics +/- ENT input if regarding airway or resp failure.
What are the complications of croup?
Dehydration due to poor fluid intake
Pneumonia due to secondary bacterial infections
Resp failure
Death is very rare ( 1 in every 30,000 cases)
What is the typical prognosis of croup?
Symptoms resolved within 48hrs but may last longer.
Occasionally, severe upper airway obstruction can occur -> resp failure and arrest.
