Croup Flashcards
What is another name for croup?
Laryngotracheobronchitis
What is the definition of croup?
A common respiratory disease of childhood characterised by a seal-like barking cough and respiratory distress
What is the pathophysiology of croup?
Viral URTI –> Nasopharyngeal inflammation –> spreads to larynx and trachea –> subglottal inflammation, oedema, and airway compromise at its narrowest portion
What causes the characteristic cough in croup?
Impaired movement of vocal chords
What are the common causative organisms or croup?
Parainfluenza viruses (types I - IV) Rhinovirus RSV Influenza Adenovirus
What % of cases of croup does parainfluenza virus types account for?
80%
What % of cases of croup does parainfluenza type I account for?
50-70%
What is the presentation of croup?
Prodrome of coryza a few days before
Hoarse voice (inflammation of vocal chords)
Barking cough (tracheal oedema and collapse)
Harsh stridor (during inspiration, usually)
Difficulty breathing
At what time of day may the symptoms if croup be worse?
At night
What signs of difficulty in breathing may there be?
Chest recession
Use of accessory muscles
How long do these symptoms last for?
3-7 days
Can be up to 2 weeks
What examination/investigation is absolutely contraindicated when suspecting croup, and why?
Tongue depressor
Due to risk of obstruction
What investigation result would indicate severe respiratory impairment in croup?
Decreased SaO2
What other important emergency Ddx should be considered (along with croup)?
Acute epiglottitis
Inhaled foreign body
Anaphylaxis
Laryngomalacia
What are the management options for croup?
Oral steroids
Nebulised budesonide
Nebulised adrenaline
Intubation
What does management of croup depend on?
Severity
Time of day
Access to hospital
Parental understanding and confidence
How are oral steroids given for croup and what effect do they have?
Single dose (mild croup) Reduce severity and duration of symptoms
What is the indication for nebulised budesonide in croup?
Chest wall recession
given in hospital
What is the management for moderate-severe croup?
Admit!
Nebulised adrenaline
Careful monitoring for recurrence of obstruction - esp. 2-3 hours after medication
What is the indication for intubation in croup?
If Sx haven’t been controlled
If pt deteriorates
What are the complications of croup?
Bacterial superinfection (pneumonia, tracheitis) Pulmonary oedema
What pathogens could be responsible for bacterial superinfection in croup?
Staph. a
GAS
Moraxella catarrhalis
What is the prognosis of croup?
Generally good
Complications are rare
What % of children need to be admitted with croup?
1.5-6%
