Paediatric upper airway Obstruction/Croup

Question 1

General notes on epiglottiitis

Question 2

differentials between epiglottitis and croup

Answer 2

CROUP
- Croup usually worse at night
- Barking cough
- Increased WOB
- Fever or wheeze may be present usually in the setting of a virus peaking day 3-4 with urti symptoms preceeding
EPIGLOTTITIS
- Consider if drooling or difficulty swallowing. Drooling without cough is suggestive of epiglottitis.
ANAPHYLAXIS
- Consider if rapid onset, other anaphylaxis symptoms, exposure to allergens

Question 3

Dexamethasone dose and strength for mild or moderate croup

Answer 3

150 mcg/kg (8mg in 2 ml = 400mcg 0.1ml)

Question 4

Dexamethasone dose for sever croup

Answer 4

160 mcg/kg (8mg in 2 ml = 400mcg 0.1ml)

Question 5

Differentials for croup

Answer 5

• Epiglottitis
• Foreign body airway obstruction
• Anaphylaxis

Question 6

Risk factors for severe Croup

Answer 6

• Age <6 months
• pre existing airway narrowing/abnormality
• Past Hx of severe croup
• Sudden onset/rapid progression of symptoms
• Complex medical conditions or those that expose patient to respiratory failure

Question 7

Epiglottitis Notes

Answer 7

• Stridor with increased WOB
• Drooling and absence of cough suspect epiglottitis
• May have a low pitched exp stridor often snoring patient may prefer to tripod or place in sniffing position
• DO NOT INSPECT the airway as this may precipitate respiratory arrest

Question 8

Suspected airway obstruction
Patial (effective cough)

Answer 8

Passive measures
- Encourage to cough
- utilise gravity
- Maintain BLS

Question 9

Suspected airway obstruction
Patial (ineffective cough)

Answer 9

-Use manual techniques as required
- Utilise gravity
- Bach slaps alternating with chest thrusts (5 per thrust/blow checking between each one)
IF BECOMES UNCINSCIOUS
-Chest compressions
- Suction
- Magills forceps
- forced ventilation
IF LOSS OF CO
-Manage as per arrest cpg

Question 10

Adrenalin dose, concentration, delivery mode.

Answer 10

5 mg of 1mg/ml = 5 ml
via a nebuliser (min vol 5 ml) at 8lt O2

Question 11

Symptoms of sever croup

Answer 11

B - Increasing drowsiness/agitation
A - Increased accessory muscles
R - Marked increase of decrease is a late sign
S - Stridor at rest
S - SpO2 < 96% Late sign

Question 12

Croup differentials

Answer 12

• Epiglottitis
• Anaphylaxis
• Asthma

Question 13

Croup focused assessment

Answer 13

• Rash
• AEIOUTIPS

Question 14

Croup risks for clinical deterioration

Answer 14

• Further deterioration of GCS
• Increased respiratory distress
• Airway obstruction
• Hypoxia