Croup Syndromes

Question 1

explain what croup syndromes are

Answer 1

-Characterized by hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress.
-Croup syndromes affect the larynx, trachea, and bronchi
(Epiglottitis, laryngitis, laryngotracheobronchitis (LTB), tracheitis)

Question 2

what are infectious agents for croup syndromes

Answer 2

-Para influenza (most often)
-Adenovirus (less often)
-Influenza (less often)
-Measles

Question 3

what is the prevention for croup syndromes

Answer 3

Haemophilus influenzae (Hib) vaccine

Question 4

what are therapeutic management for mild croup disease

Answer 4

outpatient care

Question 5

what is therapeutic management for significant croup disease (stridor at rest)

Answer 5

hospitalization supportive care including hydration and oxygen

Question 6

what is therapeutic management for severe croup disease

Answer 6

IV hydration, O2 to keep SpO2 >95%.

Question 7

what is the most common croup syndrome

Answer 7

acute laryngotracheobronchitis (LTB)

Question 8

what is acute laryngotracheobronchitis (LTB)

Answer 8

-Generally affects children younger than 5 years of age
-Organisms responsible: RSV, Para influenza virus, Mycoplasma pneumoniae, influenza A and B viruses

Question 9

what are the manifestations of LTB

Answer 9

-Inspiratory stridor
-Suprasternal retractions
-Barking or seal-like cough
-Increasing respiratory distress and hypoxia
-Can progress to respiratory acidosis, respiratory failure, and death

Question 10

what is therapeutic management of LTB

Answer 10

-Airway management
-Maintain hydration (oral or IV)
-High humidity with cool mist oxygen
-Nebulizer treatments: Epinephrine (racemic), Steroids

Question 11

what is acute epiglottitis

Answer 11

-Inflammation of the tissue that covers the trachea
-Most common in 2-5 year olds

Question 12

what are clinical manifestations of acute epiglottitis

Answer 12

-Abrupt rapidly progressive onset, high fever, refusing to drink or swallow
-Sore throat, pain, tripod positioning, retractions
-Inspiratory stridor, mild hypoxia, distress
-Potential for airway obstruction

Question 13

what are the 4 Ds of epiglottitis

Answer 13

-Dysphonia – frog-like croaking
-Dysphagia – refusing to eat
-Drooling
-Distressed respiratory effort

Question 14

what is management of acute epiglottitis

Answer 14

-Emergency!
-Examination near emergency airway equipment
-Lateral neck radiography for diagnosis
-Avoid stressing patient – keep with parent
-Administer humidified oxygen
-Prepare for intubation or emergency tracheostomy
-Steroids, IV fluids, oxygen

Question 15

what is treatment of acute epiglottitis

Answer 15

-Airway protection
-Corticosteroids
-IV fluids
-Humidified oxygen
-May need intubation or trach
-Antibiotics (if bacterial): Ceftriaxone IV, then oral,
-Treat family contacts with children under 4 with Rifampin

Question 16

what is the prevention of acute epiglottitis

Answer 16

Hib vaccine

Question 17

A nurse is assessing a child. Which of the following are clinical manifestations of epiglottitis? (Select all that apply.)

a. Hoarseness and difficulty speaking
b. Difficulty swallowing
c. Low-grade fever
d. Drooling
e. Dry, barking cough
f. Stridor

Answer 17

a. Hoarseness and difficulty speaking
b. Difficulty swallowing
d. Drooling
f. Stridor

Question 18

how is CPR different in peds

Answer 18

-Try to elicit a response (call out or flick foot for infant)
-Airway check
-30 compressions to 2 breaths.
-Compressions are fast – heel of hand for children, 2 fingers for infants
-Ask a bystander to call 911 or if alone, administer care for 20 seconds then call 911
-Heimlich over age 1, before that chest pushes and back blows