Test 5 Ch.43 Croup and Croup- Like Syndromes Flashcards
This a general term that is used to describe the inspiratory barking or brassy sound associated w/ a partial upper airway obstruction
croup
What is the inspiratory barking sound that is heard in pt’s w/ a partial upper airway obstruction
inspiratory stridor
Another term for croup is
laryngotracheobronchitis (LTB)
Primarily affects the lower laryngeal area, trachea and ocasionally the bronchi the term
laryngotracheobronchitis (LTB) is used as a synonym for “classic” subglottic obstruction
LTB is an inflammatory process that causes
edema and swelling of the mucous membranes
What is the most common cause of croup or croup-like symptoms?
LTB
This is a life-threatening upper airway obstruction caused by an invasive bacterial infection of the soft tissues of the trachea
Bacterial tracheitis
Bacterial tracheitis is still considered to be
subglottic
This is life-threatening emergency, inflammation of the supraglottic region. Includes the epiglottis, aryepiglottic folds and false vocal cords
Acute epiglottis
Airway and obstruction caused by tissue swelling and mucopurulent membranous secretions below the vocal cords (SUBGLOTTIC)
Bacterial tracheitis
Airway obstruction caused by swelling just above the vocal cords (SUPRAGLOTTIC)
Epiglottitis
Airway obstruction caused by tissue swelling just below the vocal cords (SUBGLOTTIC)
LTB
What virus causes LTB in most cases?
Parainfluenza virus
Type 1 LTB is the most
common
Type 3 is
less common
Type 2 is
infrequent
What are other viruses that LTB may be caused by (6)
- influenza A and B
- RSV
- Herpes simplex virus
- Mycoplasma pneumoniae
- rhinovirus
- adenovirus
Influenza A affects more
kids
Influenza B affects more
adults
LTB is primarily seen in children
6 months to 5 years w/ peaking at 2nd year of life
Which gender is affected more?
Boys
LTB is slow and is most common during the
fall and winter
What is helpful w/ diagnosis of LTB? (2)
- pt’s clinical history
- radiologic examination
What commonly causes Bacterial tracheitis?
Staphylococcus aureus
Other bacteria that may case BT (3)
- H. influenzae
- Beta- hemolytic streptococcus
- Streptococcus pyogens
_____________ _____________ has been implicated w/ increased frequency and is associated w/ severe BT
Moraxella catarrhalis
Rare gram-negative organism linked to BT include (2)
- Pseudomonas
- Klebsiella spp
BT is more commonly seen in the
winter months
What gender is affected in BT?
Boys
The __________ _____ radiograph will rule out epiglottis
Lateral neck
What is the most definitive method to diagnose BT
Direct visualization via laryngobronchoscopy of the airway
What is Acute epiglottitis is almost always caused by
Haemophilus influenzae type B
How is epiglottitis transmitted?
via aerosol droplets
H. influenzae type B is still responsible for about…
25% of epiglottitis cases
Other bacterial now associated w/ AE include (3)
- H. parainfluenzae
- Streptococus pneumoniae
- group A S. pyrogens
What has also been associated w/ AE in immunocompromised pts? (2)
- Candida
- Aspegillus
AE has no clear out geographic or
seasonal incidence
AE may develop in all age groups, most often occurs in
children 2 to 6 y/o
AE is usually ________
abrupt
In AE Inspiratory stridor is usually
softer and lower in pitch
AE in adults is typically seen in pts w/
neck trauma
Clinical manifestations of LTB,BT and AE
upper airway obstruction
Vitals signs (3)
- Increased RR
- Increased HR
- Increased BP
Chest assessment findings (3)
- prolonged inspiratory phase
- diminished breath sounds
- Inspiratory stridor
Lateral Neck Radiograph (3)
- haziness in the subglottic area (LTB & BT)
- haziness in supraglottic area (epiglottitis)
- classic “thumb sign”(epiglottitis)
Anteroposterior (AP) Neck Radiograph
steeple pint or pencil point narrowing of the upper airway (LTB)
Treatment is based on the cause of the
croup and croup-like syndrome
LTB uses a score table that measures the pts
stridor, retractions, air movement, color and level of consciousness
In sever BT, the administration of……. Are often required (3)
- IV antibiotics
- admission of ICU for intubation
- Vent support
The management of AE is
very specific
Once the diagnosis is suspected or confirmed by the lateral neck radiograph, an examination or inspection of the
pharynx and larynx is to be done ONLY in the operating room under general anesthesia
B/c hypoxemia and significant WOB is associated w/ LTB, BT, and AE, what tx may be required?
oxygen
Aerosolized Racemic Epi is given to children w/ LTB based on the LTB scoring system:
- age 3 to 5: consider racemic epi
- 6 and greater: administer 0.5 mL in 3mL normal saline
What does racemic epi do (pharmalogic)
it is used for vasoconstrictie effect on mucosal edema
Pts who have LTB symptoms but have BT do not
generally improve w/ racemic epi
What steroid have been shown to reduce the severity and duration of LTB in pts w/ moderate to severe symptoms?
dexamethasone
What antibiotics are commonly prescribed for pts w/ AE (2)
- Ceftriaxone (Rocephin)
- ampicillin/ sulbactam (unasyn)
What gas may be helpful in severe cases of LTB?
Heliox
Heliox is combined w/
80% of helium and 20% oxygen, which has a lower density than room air
Breathing helliox lowers the _______ throughout the breathing cycle, reducing the child’s _____ w/ __________ obstruction and preventing fatigue
Raw;
WOB;
airway
Pts w/ this, intubation is frequently required to stabilize the airway
BT
Questions from the back
The onset of LTB is usually:
24 to 48 hours
What is associated with eppiglottitis? (Bacteria)
Haemophilus influenzae type B
What clinical manifestation is associated w/ LTB
High-pitched and loud inspiratory stridor
The signs and symptoms associated w/ epiglottitis usually develop within
2 to 4 hours
Which of the following gas values are associated w/ mild to moderate LTB or epiglottitis
- Decreased PaCO2
- Increased pH
Bacterial tracheitis is most commonly caused by
Staphylococcus aureus
Inspection for croup (3)
- cyanosis
- use of accessory muscles during inspiration
- substernal and intercostal retractions
With Epiglottitis the pt usually maintains limited airway by
Sitting up and leaning forward w/ the chin protruding
Having a pt with epiglottises lie down will cause complete
Airway obstruction within minutes
