Croup Flashcards
croup
acute laryngotracheobronchitis
barking cough
hoarse voice
stridor
result of viral infection
usually mild and self limiting, typically lasting 3-7 days
consider other causes of upper airway obstruction eg inhaled foreign body
pathophysiology
viral URTI causing nasopharyngeal inflammation
may spread to larynx or trachea
can cause subglottal inflammation, oedema and compromise of the airway at its narrowest portion
movement of vocal cords impaired - cough, hoarse voice
if recurrent, its is thought there may be an allergic cause rather than a viral cause for subglottal oedema
causative organisms
parainfluenza virus types I, II, III and IV (~80%, type I 70% of severe cases) RSV adenovirus rhinoviruses enterovirus measles influenza
epidemiology
most common 6mo - 3yo
peak incidence in 2nd year of life
60 per 1000 children aged 1-2yo
risk factors
male:female 1.43:1 younger than 6 months, 1.73:1 in children 6-12 months
most prevalent in autumn and spring
presentation
starts with non-specific URTI Sx (coryzal, fever)
barking cough and coarseness after a couple of days - tend to be worse at night
mild-moderate fever
stridor
chest sounds usually normal (may be reduced if severe airflow limitation)
resp distress inc tachypnoea and intercostal recessions
red flags: lethargy, drowsiness, cyanosis despite increasing resp distress
NB even though the child whose stridor may look to be improving (reduced recessions) there may be in fact deteriorating airway obstruction. high risk of complete occlusion
DDx
epiglottitis inhaled FB acute anaphylaxis diphtheria (acute URTI infection - once known as 'the strangling angel of children') peritonsillar abscess angioneurotic oedema
assessment of severity
most commonly cited is the Westley clinical scoring system (useful in research but limited clinical usefulness) measures: stridor intercostal recession air entry cyanosis level of consciousness
management
keep child calm and comfortable paracetamol and brufen ensure adequate fluid intake steroids can ease Sx within a few hours mild - dexamethasone more severe - prednisolone
nebulised adrenaline usually reserved for moderate - severe distress
