Upper Respiratory Tract Infections Flashcards
What is Croup?
Acute Laryngotrachebronchitis (LTB) causing subglottic oedema, inflammation and exudate
What are the clinical features of croup?
Stridor (loud stridor is better than soft stridor)
Brassy barking cough
Hoarse voice
Recessions
Sudden onset with mild pyrexia and coryzal prodrome
Usually 6 months – 3 years peak age 2
Usually occurs in the Autumn following URTI
What organisms commonly cause croup?
Parainfluenza virus most common Adenovirus Influenza virus RSV Rarely Measles
How do you classify croup as mld/moderate/severe?
Mild Minimal recession/stridor/barking No cyanosis Alert Good air entry at rest
Moderate Frequent stridor and barking Stridor at rest Sternal retraction at rest Child is still interested in surroundings and not in distress
Severe Restlessness Cyanosis Recessions Stridor at rest Rising PEWS Tiredness GCS dropping
What is the management for croup?
Mild – can be sent home if clinically well and settles with some oral dexamethasone or prednisolone stat
Moderate – admit
Should aim for minimal interference and closely monitor vital signs. Give oral steroids and nebulised adrenaline
Severe – add in supplemental oxygen and if poor response to nebulised adrenaline and oral steroids (budesonide), then consider ITU and alternate diagnosis of bacterial tracheitis
How does bacterial tracheitis present and what organisms usually cause it?
Characterised by thick mucopurulent exudate and tracheal mucosal sloughing that is not cleared by coughing and risks obstruction. Presentation is gradual onset brassy cough with fever >38 and pain.
Usually caused by Staphylococcus aureus or streotococcus
How should bacterial tracheitis be managed?
Management: early intubation suctioning of respiratory secretions
Treat with Cefotaxime and Flucloxacillin
Hydrocortisone
What are the clinical features of epiglottitis?
Sudden onset Continuous stridor but softer like snoring Drooling of secretions Voice muffled – sniffling dog Toxic and feverish – T > 39 No prominent cough Age 2-6yrs
What causes epiglottitis?
Usually Haemophilus Influenzae type B
How is epiglottitis managed?
Avoid approaching the child and do NOT examine the throat or do anything to upset them
Call ENT surgeon and Anaesthetist
Take to theatre for inhalation induction of anaesthesia
If complete obstruction occurs, then tracheostomy
Treat with Cefotaxime
Hydrocortisone
What are the differentiating features of croup, bacterial tracheitis and epiglottitis?
Croup Common 6m – 6y Occurs over a few days Stridor only when upset Stridor harsh Swallows oral secretions Voice hoarse Usually apyrexial Barking cough
Bacterial Tracheitis Uncommon 6m – 14y Viral for 2-5days then rapid deterioration Continuous stridor Swallows oral secretions Very hoarse voice Moderate fever Barking cough
Epiglottitis Rare 2-7y Sudden onset Softer snoring stridor Continuous stridor Drooling of secretions Voice muffled Toxic and feverish Cough not prominent
What is the croup score?
Intercostal recession
None (0) Mild (1) Moderate (2) Severe (3)
Air entry on auscultation
Normal (0) Mildly reduced (1) Severely reduced (2)
Cyanosis
None (0) What agitated or active (4) At rest (5)
Level of consciousness
Normal (0) Altered (5)
How is the croup score utilised to guide management?
Mild = <4 – oral dexamethasone unless 0 then no treatment, <2 discharge, otherwise observe for 1 hour.
Moderate = 4-6 – senior review, oral dexamethasone or nebulised budesonide, oxygen if sats < 92%, if improving observe for 2-3 hours and discharge if score <2, if ongoing concerns then admit
Severe = >6 – urgent senior review, nebulised adrenaline, and budesonide, reassess diagnosis and notify CICU
Respiratory failure = >12 – Alert CICU, fast bleep senior, ET and anaesthetist, nebulised adrenaline and budesonide DO NOT attempt IV access unless airway secure or senior input
What is tonsilitis?
Bacterial tonsillitis most commonly caused by GABHS such as strep pyogenes. Note glandular fever or EBV often mimics bacterial tonsillitis.
What are the clinical features of tonsillitis?
Preceding coryzal
Sore throat
Difficulty swallowing
No cough (if bacterial)
