Croup (Laryngotracheobronchitis) and Epiglottitis Flashcards
What is the epidemiology of croup?
Affects about 15% of children
Presents between 6m-6yrs (most common between 1-3yrs)
More common in boys and in spring/autumn
What is the aetiology and pathophysiology of croup?
Viral URTI affecting the trachea
Most common agent is parainfluenza (also influenza); very rarely is it bacterial (used to be caused by diptheria which was frequently fatal - but vaccination does bits)
What is the presentation of croup?
Mild, usually self limiting lasting a couple of days
Characteristic presenting features = ‘barking’ cough + stridor (harsh inspiratory added breath sound) + hoarse voice
Possible: increased WOB (recession + lethargy in severe), low grade fever and coryza
Often worse at night
Hypoxia in very late stage/severe
How is croup diagnosed?
Based on Hx and after excluding more serious possibilities e.g. obstruction with foreign body or epiglottitis
How do you manage croup?
Try to keep them as calm as possible - so as not to further inflame and obstruct their airway
Usually a single dose of PO dexamethasone (0.15mg/kg) - will be enough to remediate symptoms; or neb budesonide (2mg as a single dose) or IM dexamethasone (0.6mg/kg)
If severe - give supplementary oxygen
Sometimes nebulised adrenaline is used - 1:1000 (1mg/mL) – lasts 2-3hrs – but then patient must be kept in hospital to monitor for rebound
What is acute epiglottitis?
An important differential for croup
Bacterial infection of epiglottis - Haemophilis influenzae b traditionally but with vaccines numbers have dropped (though increasing again due to poor uptake) - vaccinated at 2m/4m/6m
Also S.pneumoniae, S.pyogenes, S.aureus
How does epiglottitis present?
Rapid onset odynophagia/dysphagia
Muffled or hoarseness of voice
Stridor (soft/less significant as airway is too small)
High fever (>38)
Breathing difficulties that may correct when leaning forwards or with hyperextended neck
Drooling (as cant swallow)
No barking cough
Will look ill (unlike croup mostly)
Likely unvaccinated child
How do you diagnose epiglottitis?
DONT ANNOY THE CHILD
DONT LOOK IN THE THROAT - can cause an upper airway spasm and occlude the airway
If clinically suspected - contact anaesthetist, will be intubated; possible tracheostomy in severe cases
Once airway secure - fiberoptic laryngoscopy, throat swabs/blood tests for MC+S
ICU
How do you treat epilglottitis?
IV ABx - rifampicin or ceftriaxone
Corticosteroids - Dex - to minimise throat inflammation and swelling
IV fluids/nutrition until able to swallow again
What is the prognosis for epiglotitis?
Usually much better within 24hrs of treatment
Death is rare - <1/100
