Croup

Question 1

What is Croup

Answer 1

Croup is a viral disorder of the upper airway that normally results in subglottic swelling and obstruction.

Question 2

Laryngotracheobronchitis

Answer 2

Viral croup is usually caused by the parainfluenza virus and is the most common form of airway obstruction in children 6 months to 6 years old.

Question 3

Pathogen that causes croup

Answer 3

Parainfluenza Type I (most common), Adenovirus, RSV Rarely bacterial (Mycoplasma Pneumonia)

Question 4

What may worsen croup

Answer 4

Bacterial superinfection with Staphylococcus aureus, group A Streptococcus pyogenes, or Haemophilus influenzae may worsen croup.

Question 5

Pathology of croup

Answer 5

Inflammation, edema, epithelial shedding in the glottic, subglottic areas Mainly upper airway, but can have lower airway involvement It can involve the airways from the larynx to the bronchus.

Question 6

What are the initial signs of croup

Answer 6

URI Symptoms become evident after 2 or 3 days of nasal congestion, low grade-moderate fever, dehydration, hoarse and coughing. A child typically has slow, progressive inspiratory and expiratory stridor and a barking seal like cough.

Question 7

Signs of Impending Respiratory DIstress

Answer 7

Increased work of breathing at rest with intercostal and substernal retractions, increasing O2 requirements and lethargy are signs of impending respiratory failure As the disease progresses, dyspnea, cyanosis, exhaustion, and agitation occur.

Question 8

X-Ray in Croup

Answer 8

Classic croup is seen on an anteroposterior radiograph as characteristic subglottic narrowing of the trachea, called the steeple sign Sharply sloped, wedge shaped, linear narrowing of the trachea

Question 9

Medications in Croup

Answer 9

Corticosteroids and epinephrine have been shown to have the greatest benefit for decreasing the length and severity of respiratory symptoms associated with viral croup. o Oral dexamethasone (0.6 mg/kg) o Racemic Epinephrine (1:1000 mg)-5 ml The addition of budesonide has been shown to reduce the severity of symptoms in mild to moderate cases of croup.

Question 10

What is the most common cause of croup?

Answer 10

Parainfluenza 1, 2, 3 and could be any virus.

Question 11

Why is croup syndrome more susceptible to infants and children?

Answer 11

Infant and small children are more susceptible to this disease because their airways are smaller.

Question 12

What are the types of URI’s in children?

Answer 12

Acute nasopharyngitis (common cold) caused by numerous viruses such as RSV, rhinovirus, adenovirus, influenza, and parainfluenza viruses. Fever varies with the child’s age. Older children have low-grade fevers. Symptoms can last up to 10 days and home management varies with age.

Question 13

Croup/Laryngotracheobronchitis

Age of Onset

Answer 13

• Age of onset: 6 months - 3 years
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Question 14

Croup/Laryngotracheobronchitis

Clinical Manifestations:

Answer 14

• Barking, seal-like cough
• Hoarse voice
• Stridor
• Low grade-moderate Fever
• Dehydration
• Increased work of breathing at rest with intercostal and substernal retractions, increasing O2 requirements and lethargy are signs of impending respiratory failure

Question 15

Croup/Laryngotracheobronchitis

CXR

Answer 15

• CXR reveals classic “steeple sign”
• Sharply sloped, wedge-shaped, linear narrowing of the trachea

Question 16

Croup/Laryngotracheobronchitis

Treatment

Answer 16

Supportive care –keeping the patient comfortable

Humidification

Supplemental oxygen

Systemic Corticosteroids

If obstruction becomes serious, may need intubation

MINIMAL HANDLING/AGITATION DURING DIAGNOSIS and TREATMENT