Croup Flashcards
What is croup? What is it also known as?
Croup (aka laryngotracheobronchitis) is a viral inflammation of the upper airway, larynx, trachea and bronchi. It is worse at night and it peaks on the 2nd or 3rd night.
Who gets croup?
Common in children
What are the 3 main differential diagnoses for croup?
Inhaled foreign body
Epiglottitis
Bacterial Tracheitis
What are the main pathogens which cause croup?
Parainfluenza (75%), Influenza A and B, RSV, Adenovirus
What is important to remember when assessing a patient with croup?
Children with croup should have minimal examination. It is very important to not examine the throat and further upset the child. Do not change the child’s posture as the child will adopt the posture that minimises airways obstruction.
What are the risk factors for severe croup?
Pre-existing narrowing of the upper airways: subglottic stenosis (congenital or prolonged neonatal ventilation) OR Down’s Syndrome
Previous admissions with severe croup
Uncommon
What are the clinical features on history associated with croup?
Common prodrome: rhinorrhoea, pharyngitis, cough, +/- fever
Symptoms: Stridor (usually present first to hospital with the stridor), barking cough, hoarse voice, worse at night
What are the clinical features on examination associated with croup?
Barking cough Inspiratory stridor May have associated widespread wheeze Increased WOB May have fever, but no signs of toxicity
What are the different categories of the severity of croup and how do they differ?
The categories are mild, moderate and severe and this is based on 5 parameters. Behaviour, stridor, respiratory rate, accessory muscle use, oxygen.
Behaviour: normal -> some/intermittent irritability -> increasing irritability and/or lethargy
Stridor (the loudness of the stridor is not a good guide to the severity of the obstruction): barking cough, stridor only when active or upset -> some stridor at rest -> stridor present at rest
Resp. Rate: normal -> increased RR, tracheal tug, nasal flare -> marked increase or decrease, tracheal tug, nasal flaring
Accessory muscle use: none/minimal -> moderate chest wall retraction -> marked chest wall retraction
Oxygen: none -> none -> hypoxaemia is a late sign of significant upper airway obstruction
Do you investigate a child with suspected croup? If so, what tests do you do?
No investigations are usually conducted on a child with croup because it may cause the child distress and worsening of the symptoms. It is mainly a clinical diagnosis so the lack of investigations is ok.
What are some important considerations to make in the acute management of croup?
Minimal handling is important in children with croup. Limiting examination, nursing with parents. Supplemental o2 is not required. IV access should be deferred. Avoid distressing the child further.
How do you treat mild to moderate croup?
PREDNISOLONE 1mg/kg and prescribe another dose for the next evening OR single dose of ORAL DEXAMETHOSONE
Observe for half an hour post steroid administration and discharge once stridor free at rest
How do you treat severe croup?
Nebulised Adrenaline AND 0.6mg/kg IM/IV Dexamethasone
Improvement – observe for 4hrs post adrenaline. Consider discharge when stridor free at rest
Improvement the Deterioration – give further doses of adrenaline. Consider admission.
No improvement – reconsider diagnosis. Acute upper airway obstruction.
What are the discharge requirements for a patient with diagnosed croup?
Four hours post nebulised adrenaline (if given) and/or half an hour post steroids and stridor free at rest.
