Croup, Bacterial Tracheitis, Epiglottis, IFB Flashcards
Epidemiology of Croup (acute laryngotracheobronchitis)?
Commonest in the autumn, occurs from 6 months to 6 years of age but peak incidence is around 2 yrs.
Viral croup accounts for 95% of laryngotracheal infections.
Aetiology of Croup?
1) Parainfluenza type 1 or 3 - MOST COMMON CAUSE!
2) RSV, Influenza, human metapneumonovirus
Pathophysiology of croup?
1) Subglottic oedema - can be dangerous if it results in the critical narrowing of the airway.
2) Mucosal inflammation
3) Increased secretions of the airway
Clinical presentation of croup?
1) Usually preceded by fever (<38.5 degrees) and coryza
2) Develops harsh stridor - high pitched, vibratory, inspiratory sound
3) Hoarseness from obstruction in the larynx region
4) Barking cough (like a seal)
5) Chest recessions
6) Symptoms often start and are worse at night
Differential diagnosis of croup?
1) Bacterial tracheitis
2) Inhaled Foreign Body
3) Acute epiglottitis
Diagnosing Croup?
1) CLINICAL: Mild - no stridor at rest, stridor only on activity or when upset, no recession, no cyanosis, child is alert.
Severe - Stridor at rest, restless, recession present, cyanosis present, altered conscious level.
2) FBC, CRP, U+E, CXR, pulse oximetry for exclusion, consider distress it can cause.
Treating Croup?
1) Mild: Oral Dexamethasone or Nebulised Budenoside, can be sent home if it settles
2) Severe: Dexamethasone or Nebulised Budenoside AND:
Nebulised adrenaline and oxygen by facemask - (adrenaline provides fast symptom relief should improve stridor temporarily).
(Short course steroid)
Monitor closely due to risk of rebound systems once adrenaline wears off, however, if stridor still fails to respond to (steroid and adrenaline) - consider brachial tracheitis.
What is Bacterial tracheitis (Pseudomembranous to croup)?
1) Rare but dangerous condition similar to croup
2) Presence of thick mucus exudate and tracheal mucosal sloughing that is not cleared by coughing - risks occluding airway.
Caused by staphylococcus aureus
Clinical Presentation of bacterial tracheitis?
1) High fever (bacterial) - ook unwell
2) Rapidly progressive airways obstruction
3) Copious thick airway scectretions.
4) Harsh, loud stridor, hoarseness, barking cough
Treatment of bacterial tracheitis?
1) IV Cefotaxime and Flucloxacillin
2) Intubation and ventilation if required
What is acute epiglottitis? Who does it affect the most and what?
Results in acute swelling (in minutes) of the epiglottitis and surrounding tissue around the airway obstruction - it is associated with septicaemia. Most common from 1-6 years old.
Cause of Epiglottitis?
Haemofluenza influenza type B (HIB) - Introduction of vaccine has led to 99% reduction in infancy.
Clinical presentation of epilglottitis?
1) High fever (>38.5 degrees)
2) Intensely painful throat that prevents child from speaking/swallowing properly
3) Saliva drooling down chin
4) Child sits immobile, upright, with mouth open to optimise airway
5) Soft, inspiratory stridor with rapidly increasing respiratory difficulty
How to treat and investigate epigottitis?
1) Urgent hospital admission required if acute epiglottitis is suspected.
2) Senior anaesthetist, paediatrician and ENT surgeon required.
3) Do not approach child or examine throat - increases distress in child and worsen obstruction.
4) Intubate child if possible under general anaesthetic, tracheostomy may be squired if complete obstruction.
5) Once airway is secured - cultures should be taken
6) IV Cefotaxime
7) Prophylaxis of household contacts with Rifampicin if - H.Influenzae isolated on cultures
Inhaled foreign body presentation? How do you treat?
1) No fever
2) Monophonic wheeze
If ineffective cough:
Unconscious - open airway, 5 breaths and CPR
Conscious - 5 back blows, 5 thrusts (chest for infant, abasement for child >1)
If effective cough:
Encourage cough and check for deterioration
