Respiratory: Croup, Epiglottitis & Whooping Cough Flashcards
What is croup also known as?
Laryngotracheobronchitis
What is croup?
A common viral infection of the UPPER airways in children, causing oedema in the larynx.
What age does croup typically affect?
Commonly affects children who are aged 6 months – 3 years, but can affect those who are as young as 3 months.
Peak incidence is at 2 years of age.
Typical symptoms seen in croup?
Inflammation of the larynx causes:
1) barking cough
2) stridor
3) may have low fever
What is typically seen prior to croup presentation?
A prodromal period of non-specific upper respiratory tract symptoms (coryza, non-barking cough, mild fever) may occur for 12-48 hours.
How long does the barking cough and respiratory distress typically last in croup?
1-2 days before recovery.
What time of year is croup more common?
Autumn
What is the classic cause of croup?
Parainfluenza virus.
What are the viruses that can cause group?
1) Parainfluenza virus (most common)
2) Influenza A and B
3) Measles
4) Adenovirus
5) Respiratory syncytial virus (RSV)
What did croup USED to be caused by?
Diptheria
Croup caused by diphtheria leads to epiglottitis and has a high mortality. Vaccination mean that this is very rare in developed countries.
What bacteria can cause croup?
1) Staph. aureus
2) Strep. pneumoniae
3) Haemophilus influenzae
4) Moraxella catarrhalis
How is croup spread?
Where can outbreaks occur?
Croup is droplet spread and outbreaks can occur in childcare settings or school, most commonly in autumn.
Is croup more common in males or females?
Males
Pathophysiology in croup?
1) Following a coryzal prodrome, white blood cells infiltrate the larynx, trachea and large bronchi, causing inflammation.
2) This inflammation causes oedema which results in partial airway obstruction.
3) When significant, this airway obstruction dramatically increases the work of breathing and causes the characteristic turbulent airflow known as stridor.
Clinical features of croup?
1) coryzal prodrome which then progresses over 12 to 48 hours
2) low fever (<38)
3) hoarseness
4) barking cough, occurring in clusters of coughing episodes
5) stridor (insidious and progressive)
6) as airway obstruction progresses, features of respiratory distress may develop:
- Tachypnoea
- Cyanosis
- Head bobbing
- Nasal flaring
etc
What scoring system for croup can helps to categorise children based on their presenting clinical features?
Westley Croup Score
What categories are there for the Westley Croup Score?
1) Mild: 0-2
2) Moderate: 3-5
3) Severe: 6-11
4) Impending respiratory failure: 12-17
How is a diagnosis of croup usually made?
Croup is a primarily clinical diagnosis, suggested by the presence of barking cough and stridor, especially in the context of a local community outbreak.
Differentials for croup?
1) Viral upper respiratory tract infection (URTI)
2) Bronchiolitis
3) Epiglottitis
4) Foreign body aspiration
Give the differing features for croup vs epiglottitis:
a) time course
b) features prior
c) cough
d) feeding
e) mouth
f) toxic
g) fever
h) stridor
i) voice
a) croup: days, epiglottitis: hours
b) croup: coryza, epiglottitis: none
c) croup: barking, epiglottitis: slight if any
d) croup: can drink, epiglottitis: no
e) croup: closed, epiglottitis: drooling saliva
f) croup: no, epiglottitis: yes
g) croup: <38.5, epiglottitis: >38.5
h) croup: rasping, epiglottitis: soft
i) croup: hoarse, epiglottitis: weak or silent, ‘hot potato voice’
Most children with mild croup can be managed at home.
Who can you consider admission in?
1) Previous history of severe airway obstruction
2) < 6 months of age
3) Immunocompromised
4) Have had inadequate fluid intake
5) Have had a poor response to initial treatment
6) The diagnosis is uncertain
7) There is significant parental anxiety
What does management of croup involve in primary care (mild illness)?
1) Supportive care
2) Oral dexamethasone
3) Arrange follow-up, using clinical judgment to determine the appropriate interval.
What medication does croup respond well to?
Steroids, especially dexamethasone.
What advice can be given to parents about managing croup at home?
1) Explaining that the symptoms usually resolve within 48 hours but may last for up to a week.
2) Explaining that croup is a viral illness and antibiotics are not needed.
3) Paracetamol or ibuprofen can be used to control pain and fever.
4) Ensure that the child has an adequate fluid intake.
5) The need to check on the child regularly, including through the night.
6) To seek urgent medical advice if symptoms worsen e.g. the development of intermittent stridor at rest or if the child starts to have a high fever and heart rate (this could indicate a different diagnosis such as bacterial tracheitis).
7) To call an ambulance if the child starts to show signs of respiratory failure.
Management of mod-severe croup in hospital?
1) Give a single dose of oral dexamethasone (0.15mg/kg body weight) or oral prednisolone (1-2mg/kg body weight)
2) Nebulised adrenaline can be given to provide temporary relief of symptoms
3) Ensure the child is kept as calm as possible as continuing crying increases oxygen demand & causes respiratory muscle fatigue
4) Oxygen therapy as required
5) Contact ENT and an anaesthetist if there is need for airway support
What dose of oral dexamethasone is given in croup?
0.15mg/kg body weight
What 2 medications are used in the management of severe croup?
1) oral dexamethasone/prednisolone
2) nebulised adrenaline
Why is it important to keep the child as calm as possible in croup?
As continuing crying increases oxygen demand & causes respiratory muscle fatigue.
Complications of croup?
Complications are generally due to airway obstruction caused by the oedema.
1) Respiratory distress: may progress to respiratory failure in some cases and even death.
2) Pneumonia
3) Pulmonary oedema
4) Epiglottitis
5) Bacterial tracheitis
What is epiglottitis?
A life-threatening medical emergency characterised by inflammation of the epiglottis and surrounding supraglottic structures.
