Croup Flashcards
What is Croup?
- inflammation of the upper respiratory tract (predominantly the larynx and trachea but it may affect the bronchi) as a result of viral infection
What is the Px of croup?
- Viral upper respiratory tract infection (URTI) causes nasopharyngeal inflammation that may spread to the larynx and trachea, causing subglottal inflammation, oedema and compromise of the airway
- movement of the vocal cords is impaired leading to the characteristic cough
- fibrinous exudation with pseudomembrane formation may occur, causing further airway compromise
What is the CO of croup?
- Parainfluenza virus types I, II, III and IV (80%)
- Respiratory syncytial virus.
- Adenoviruses.
- Rhinoviruses.
- Enteroviruses.
- Measles.
- Metapneumovirus.
- Influenza A and B
Which age group does croup affects?
- 6months - 3years
What is the presentation of croup?
Starts with
- runny nose, sore throat, fever and cough
Progress to
- barking cough and hoarseness.
- Stridor (harsh, low-pitched noise heard during inspiration)
- Respiratory distress with marked tachypnoea and intercostal recession
What are the red flag sx for impending respiratory failure shown in a child with croup?
- Drowsiness
- lethargy
- cyanosis despite increasing respiratory distress
What signs would you note for a child deteriorating with worsening airways obstruction?
- stridor appears to be improving
- intercostal recession has disappeared
What are the differential diagnosis for Croup?
- Epiglottitis.
- Inhaled foreign body.
- Acute anaphylaxis.
- Bacterial tracheitis.
- Diphtheria.
- Peritonsillar abscess (quinsy).
- Retropharyngeal abscess.
- Vocal cord paralysis
What scoring system is used to assess severity of croup?
Modified Westley clinical scoring system
What parameters are calculated in the modified Westley Clinical Scoring System?
- Inspiratory stridor
- Intercostal recession
- Air entry
- Cyanosis
- Level of consiousness
What score would indicate mild, moderate or severe croup?
- 0-3 = mild croup
- 4-6 = moderate croup
- >6 =severe croup
When would you assess a child with croup in hospital?
- Moderate or severe croup, or impending respiratory failure.
- Any suspicion of epiglottitis, bacterial tracheitis, peritonsillar abscess, retropharyngeal abscess, or laryngeal diphtheria.
- Any suspicion of inhaled foreign body, angioneurotic oedema, hypocalcaemic tetany, or ingestion of corrosives.
When would you admit a child with croup to hospital?
- History of severe obstruction, previous severe croup, or known structural upper airways abnormalities
- Age less than 6 months.
- Immunocompromised.
- Inadequate fluid intake.
- Poor response to initial treatment.
- Uncertain diagnosis.
- Significant parental anxiety
What ix would you order for croup?
Clinically diagnosed
- low SaO2 on pulse oximetry (<95%) i- significant respiratory impairment
- rapid influenza A test
- Blood test
- CXR
*weigh benefits of ix vs distressing child more
How would you mx croup?
- Keep the child as calm and as comfortable as possible
- paracetamol or ibuprofen - control fever
- Ensure an adequate fluid intake
- Steroids
- Adrenaline
