M7 - Croup

Question 1

Croup is a common cause of ____ ___ in ____ ____. It is usually ___ and ___-____. Croup is the clinical syndrome of a ____ ____, ____ ____, and ____ ____. It is usually cause by a ____ ____ of the ___ ___ that results in ____ of the ____, ____ and _____, thereby compromising airflow through the _____ airway. It mostly affects children between _-__ months, although may occur in ___ ___ and ____.

Answer 1

Airway obstruction; young children
Mild; self-limiting
Hoarse voice; barking cough; inspirations stridor
Viral infection; upper airway; inflammation; larynx, trachea, bronchi; proximal
6-36 months; older children; adults.

Question 2

As there are a number of structural and infective conditions that may also cause ____ ____ ____ similar to croup, paramedics should consider three factors when deciding whether the presence of stridor and the use of accessory muscles of respiration relate to croup or an alternate diagnosis:

• ___ of the child:
  
  • a child ______ is likely to have a ____ airway problem with or without an inter current viral infection
  • a child between _ and __ ____ with the acute onset of respiratory difficulty without ____ may have an ____ ____ ____. Bronchial ____ ___ will usually have an associated ____ rather than ____ stridor.
• ___ of the ____:
  The combination of ___ and ____ ____ increases the likelihood of an underlying ____ ___ _____ which will require urgent assessment by a paediatrician
• ____ of the child:
  Children with croup (do/do not) appear toxic (___, very ____, and ___ ___). Croup may be classified as mild, moderate, or severe depending on the presence of ____ and the degree of ___ ____. Mild croup (does/does not) require pharmacological treatment. Moderate croup requires ___ and ___ ___ for ____ to severe croup. Severe croup is ___ ___ and requires ___ ___ pre-hospital. Persisting ____ at rest is a sign of ____ croup. AS the symptoms progress, ___ may persist or decrease and become ___ as the patient _____.

Answer 2

Upper airway obstruction

AGE

• <3 months; structural
• 1-3 years; fever; inhaled foreign body; foreign bodies; wheeze; inspirations

CHARACTER; STRIDOR
Inspiratory and Expiratory stridor; fixed tracheal obstruction

TOXICITY
Do not; pale, very febrile, and poorly perfused; 
stridor; breathing difficulty
Does not
Oxygen; close monitoring; deterioration 
Life threatening; nebulised adrenaline
Stridor; moderate
Stridor; softer; deteriorates

Question 3

Symptoms of Mild; Moderate; Severe Croup

Answer 3

Mild: Barking cough; nil or intermittent stridor; no cyanosis

Moderate: Barking cough; persistent stridor at rest; some tracheal tug and chest wall recession; can be placated, interested in surroundings; may have cyanosis

Severe: Persistent/soft stridor at rest; marked tracheal tug and chest wall recession; apathetic or restless/cyanosis; palpable paradox

Question 4

Management of Mild, Moderate, and Severe Croup

Including medications, dose, route, repeats, max x1

Answer 4

Mild: transport to hospital

Moderate: Oxygen if indicated, transport to hospital

Severe: Urgent transport to hospital (A8)
Adrenaline 1:1,000 (201) via neb and O2 8L/min
<16yo: 500mcg/kg NEB, Max bolus 5mg, repeat 30min whilst indicated, no max.

Regularly repeat and document ABCD physical examinations and physiological observations in order to identify trends in clinical deterioration