Croup Flashcards
What is croup?
Viral upper respiratory tract infection which results in mucosal inflammation anywhere between the nose and the trachea
What are the most common viral causes of croup?
Parainfluenza virus - 1,2,3,4 Respiratory syncytial virus Adenovirus Rhinovirus Enterovirus Measles Meta pneumovirus Influenza A and B Mycoplasma pneumoniae
What are the risk factors for croup?
Male
Autumn and spring
What is protective of croup?
CD14 C-159T gene
Describe the typical history of croup
1 to 4 day - non specific cough, rhinorrhoea, fever progressing to a barking cough and hoarseness
Symptoms worse at night
What are some red flags in the history of croup suggestive of respiratory failure
Drowsiness
Lethargy
Describe the examination findings of croup
Stridor
Chest sounds may be normal - if airflow is limited and these sounds may decrease
Resp distress - tachypnoea, tachycardia
What are some red flags on examination of respiratory failure
Cyanosis Lethargy Decreased level of consciousness Laboured breathing Tachycardia
What do the presenting symptoms of croup vary with?
Severity of disease
Give the name of the classification scoring system used in croup
Westley croup score
List the classifications of croup
Mild
Moderate
Severe
Impending respiratory failure
Describe mild croup
Score <2
Occasional barking cough
No stridor at rest
Mild/no retractions
Describe moderate croup
Score 3-7 Frequent barking cough Stridor at rest Mild/moderate retractions Distress and agitation
Describe severe croup
Score 8-11 Frequent barking cough Stridor at rest Marked retractions Significant distress and agitation
Describe croup with impending respiratory failure
Score >12 Decreased level of consciousness Poor air entry Stridor at rest Severe retractions Pallor/cyanosis
Which factors make up the Westley croup score?
Level of consciousness Cyanosis Stridor Air entry Retractions
Give the differential for croup
Epiglottitis Inhaled foreign body Inhaled noxious substance Acute anaphylaxis Bacterial tracheitis Diphtheria Laryngomalacia Peritonsillar abscess Angioneurotic oedema Laryngeal mucosal lesions Vocal cord paralysis
Describe the differences between croup presentation and epiglottitis
Croup - Days, coryza preceding, barking cough, can drink, mouth closed, fever <38.5, rasping stridor, hoarse voice
Epiglottitis - Hours, no coryza preceding, slight cough, drooling, fever >38.5, soft stridor, weak/silent voice
How is croup diagnosed?
Mainly clinical diagnosis
Bloods - FBC, CRP, U&Es
Pulse oximetry
CXR - rule out other differentials
Where is mild croup mostly managed?
At home
When should you consider admitting mild croup?
Previous history of airway obstruction <6months of age Immunocompromised Inadequate fluid intake Poor response to initial therapy Uncertain diagnosis Significant parental anxiety
What advice should be given to parents looking after their croup kids at home?
Symptoms resolve within 48hrs to a week
Croup is viral illness so antibiotics are not needed
Paracetamol and ibuprofen used to control pain and fevers
Seek urgent advice if symptoms are worsening
Look out for signs of resp failure and call ambulance
When should immediate hospital admission occur?
Moderate/severe croup or impending resp failure
Serious disorder caused by infection
How should all children with croup be treated?
Single dose oral dexamethasone 0.15mg/kg or oral prednisolone 1-2mg/kg
Nebulised adrenaline for symptomatic relief
Keep child calm
O2 therapy as required
Contact ENT and anaesthetist if airway support needed
List the complications of croup
Lymphadenitis Otitis media Dehydration Bacterial superinfection - pneumonia or bacterial tracheitis Pulmonary oedema and pneumothorax
