Croup and Bacterial Tracheitis Flashcards
What is Croup?
What is it caused by?
A viral URTI which causes muscosal/nasopharyngeal inflammation and increased secetions affecting the airway
It may spread to the larynx and trachea, causing subglottal inflammation, oedema and compromise of the airway.
Most commonly parainfluenza virus but can be caused by many viruses such as metapneumovirus, RSV and influenza
What is the common presentation of croup?
(age and symptoms)
- Infant 6months - 6 years old (peak incidence aged 2)
Croup is charcterised by mucosal inflammation and increased secretions affecting the airway. Therefore gives the symtpoms of:
- sore throat
- ‘barking’ cough
- harsh stridor and hoarseness
- worse at night
- onset over days
- no fever or drooling salvia
Is usually preceded by fever and coryza
How should crop be managed if it the airway obstruction is mild?
(the stridor and chest recessions disappear at rest)
The child can be managed at home but parents need to observe the child closely
How is croup managed if it isn’t mild?
First line:
- Oral dexamethasone. (other steroids can be used such as oral prednisolone and nebulised steroids)
Severe croup (aka no improvement) :
- Nebulised epinephrine (adrenaline) with oxygen by facemask provides transient improvement
Ensure there is anaethetist/intensive monitoring as rebound symptoms often occur after 2 hours.
What are the major differentiating features between croup and epiglottitis?
- Onset?
- Preceding coryza?
- Cough?
- Onset Croup develops over days, epiglottitis over hours
- Coryza Croup yes, epiglottis no
- Cough Croup a barking cough is a significant feature, epiglottitis cough is not common
What are the major differentiating features between croup and epiglottitis?
- Able to drink?
- Drooling?
- Appearance?
- Drink Croup yes, epiglottis no
- Drooling Croup no, epiglottis yes
- Appearence Croup unwell, epiglottis toxic and very ill
What are the major differentiating features between croup and epiglottitis?
- Fever?
- Stridor?
- Voice, cry?
- Fever Croup <38.5, epiglottis >38.5
- Stridor Croup harsh & rasping, epiglottis soft & whispering
- Voice Croup hoarse, epiglottis muffled, reluctant to speak
What advise would you give to parents about how to care for a child with viral croup
- Close monitoring
- Support
- Reassurance
What are differential diagnosis’ for the various causes of upper airway obstruction?
- Croup
- Epiglottis
- Inhaled forgein body
- Trauma
- Smoke inhalation
- Bacterial tracheitis or congential
What is bacterial tracheitis?
It is a rare & dangerous bacterial infection of the trachea and may occur following a URTI.
This condition is also called pseudomembranous croup
.
What is the cause of bacterial tracheitis?
Staph aureus
How does bacterial tracheitis present?
(Age and symptoms)
More common in young children highest incidence at 4yo, but can occur unto 16yo.
Presents very similarly to croup. However the child will appear more ill and have a very high fever and more rapidly progressing airway obstruction. It often presents as croup which is not responding to treatment.
How do you manage bacterial tracheitis?
IV antibiotics (staph aureus infection)
Intubation if required
