Croup and epiglottitis

Question 1

typical symptoms of group

Answer 1

characteristic ‘barking’ cough

Symptoms often increase with agitation e.g. if the child is upset, crying and a harsh inspiratory noise (stridor) may become apparent

Question 2

croup is also called

Answer 2

laryngotracheobronchitis

Question 3

what causes croup

Answer 3

virus- parainfluenza virus

Question 4

croup affects the

Answer 4

larynx and trachea

Question 5

treatment of croup

Answer 5

In most instances croup does not require a hospital admission and can be safely treated by the GP with the child remaining at home (calming infant [crying makes symptoms worse], sitting them upright and a single dose of corticosteroid medication)

Question 6

croup is commonly seen in

Answer 6

young children between 6 months and three years

Question 7

outline severe symptoms of croup

Answer 7

e.g. presence of stridor at rest, respiratory distress, cyanosis (and/or parental anxiety) often lead to infants with croup presenting to the Emergency Department, especially overnight when symptoms are typically worse.

Question 8

what is given if there is stridor at resrt

Answer 8

nebulised adrenaline and oxygen can be given through a mask, in addition to the corticosteroids.

Question 9

what is epiglottitis

Answer 9

inflammation (secondary to infection) causing swelling of the epiglottis and supraglottic tissues: it is thankfully rare, but should not be missed if it presents.

Question 10

epiglottitis affects

Answer 10

infants aged 2- 6 years (but can affect any age), which can deteriorate quite quickly.

Question 11

outline what happens in epiglottitis

Answer 11

The inflammation of the epiglottis/supraglottic tissues leads to obstruction of the airway.

Question 12

presentation of epiglottitis

Answer 12

Children with epiglottitis present with difficulties breathing (stridor may be audible), and difficulties swallowing leading to pooling and drooling of saliva. Other symptoms include high fever, sore throat and attempts to keep their airway as patent as possible (sitting upright, “sniffing position” of their head- slight extension of the head at the neck )

Question 13

what should you not do with epiglottitis

Answer 13

Children with suspected epiglottitis should NOT have their throat examined or have anything placed inside their mouth as this can cause significant deterioration in their symptoms; causing a child who was just about managing to get some air in and out of their airway to it completely closing off as the child becomes upset by attempts to examine him/her.

Question 14

treatment of epiglottitis

Answer 14

Urgent treatment is required to provide an alternative airway usually either via intubation or a tracheostomy.

Question 15

underlying cause of epiglottitis

Answer 15

Haemophilus influenza type b bacteria, is treated with a course of antibiotics.

Question 16

prevention of Haemophilus influenza type b

Answer 16

The Hib vaccination has been very effective in preventing infants from contracting Hib, as such epiglottitis is now rare in the UK (though some cases do occur in adults or children who are not vaccinated).

Question 17

why does ‘head tilting’ help breathing

Answer 17

Extension at the neck and elevation of the mandible increases the patency of the upper airway- nicely demonstrates how simple airway maneouvres (head tilt and a chin lift) can improve airway patency