Croup

Question 1

What is the ddx of croup?

Answer 1

Epiglottitis, retropharyngeal abscess, bacterial tracheitis, foreign body, congenital (laryngomalacia, subglottic stenosis, vascular ring, cor paresis), anaphylaxis/angio-oedema, airway injury

Question 2

Describe mild croup.

Answer 2

Normal behaviour, no stridor or only when active/upset, normal RR, none/minimal accessory muscle use

Question 3

Describe moderate croup.

Answer 3

Intermittent/mild agitation, intermittent stridor at rest, increased RR, moderate chest wall retraction

Question 4

Describe severe croup.

Answer 4

Increasing agitation –> drowsiness, persistent stridor at rest, marked increased/decreased RR, marked chest wall retraction, hypoxia is a late sign indicating life-threatening croup

Question 5

What are the features to comment on when describing croup?

Answer 5

Behaviour, stridor, RR, accessory muscle use, oxygen saturations

Question 6

What are the risk factors for severe croup?

Answer 6

Pre-existing narrowing of upper airways, previous admissions for severe croup, young age

Question 7

In what children is croup unlikely?

Answer 7

Uncommon in <6 months, rare <3 months of age. Typically occurs between 6 months and 6 years of age.

Question 8

What are typical exam findings with croup?

Answer 8

Barking cough, inspiratory stridor, hoarse voice, widespread wheeze, increased WOB, may have fever but should not look toxic

Question 9

List the treatment of mild/moderate croup.

Answer 9

Dexamethasone 0.15 mg/kg orally OR prednisolone 1 mg/kg orally with a repeat dose the following day.

Watch until are stridor free at rest and then discharge.

Question 10

Discuss your treatment of severe croup.

Answer 10

Nebulised adrenaline 0.5 mg/kg of 1:1000 to a max of 5 ml (5 mg) undiluted OR 0.5 ml of 1% respiratory solution (10 mg/ml) diluted to 4 ml

AND

Dexamethasone 0.6 mg/kg (max 12 mg) IM/IV/PO

Question 11

If a patient with mild/moderate croup cannot tolerate oral steroids, what could you consider?

Answer 11

Nebulised budesonide 2 mg

Question 12

Describe your management of life-threatening croup.

Answer 12

Call for help. Nebulised adrenaline 0.5 ml/kg of 1:1000 to max of 5 ml (5 mg) + oxygen 15 L/min via non-rebreather mask + systemic corticosteroids

Question 13

How soon after treatment can patients with mild, moderate and severe croup go home?

Answer 13

If required adrenaline then can discharge at 4 hours if stridor-free. With mild/moderate can go home 30+ minutes after steroids if stridor-free at rest.