Breathless and Noisy Breathing

Question 1

Key diagnostic features of croup

Other common diagnostic factors

Answer 1

Distinctive seal-like barky cough
Age 6 months to 6 years
Symptoms increasing with agitation

Male
Late autumn
Prodromal symptoms - non-specific URTI for 12-48 hours
Abrupt onset
Worse at night
Hoarse voice

Question 2

What is croup?

Answer 2

AKA Laryngotracheobronchitis

Common respiratory disease of childhood characterised by seal-like barky cough, often accompanied by stridor, voice hoarseness, and respiratory distress.

Symptoms result of upper-airway obstruction due to generalised inflammation of the airways due to viral infection (usually parainfluenza type 1 and 3)

Question 3

Treatment of croup

Answer 3

Assess severity (mild, moderate, sever, impending respiratory failure)

Administer oral dexamethasone (0.15mg/kg)
Admit all children with moderate/severe symptoms

Question 4

Differential diagnosis for croup

Answer 4

Epiglottitis (unlikely with H influenza vaccine)
Foreign body aspiration
Anaphylaxis
Bacterial tracheitis

Question 5

Leading casues of stridor in children

Answer 5

Viral croup
Bacterial tracheitis
Epiglottitis (rare since haemophilus vaccination)

Consider foreign object or laryngomalcia

Question 6

Signs of croup (laryngotracheobronchitis)

Answer 6

Stridor
Barking cough - like a seal
Voice hoarseness from obstruction in region of larynx

Question 7

Croup:

• Age
• Epidemics
• Causes

Answer 7

<6 years but can be recurrent in older atrophic children
Autumn
Parainfluenza virus 1, 2, 3; respiratory synctial virus, measles (rare)

Question 8

Pathology of croup

Answer 8

subglottic oedema
inflammation
exudate

Question 9

Severe signs of croup

Answer 9

Restlessness; cyanosis
Recession; stridor at rest
Rising pulse/ Respiratory Rate
Tiredness 
Altered conscious level
In severe croup stridor will be soft

Question 10

What is bacterial tracheitis

Answer 10

Mucopurulent exudate
Tracheal mucosal sloughing not cleared by coughing
Often a history of viral infection with acute deterioration

Question 11

What is a tracheal tug?

Answer 11

Retraction at the suprasternal notch
In-drawing of the intercostal and subcostal areas
Indicates firther signs of increased respiratry effort

Question 12

Treating severe croup

Answer 12

Nebulised Adrenaline 5mls 1:1000 - can reduce swelling (short half life so must be monitored as can rebound)

Oral dexamethasone

Question 13

what is anaphylaxis?

Answer 13

Hypotension, Bronchoconstriction or Airway compromise

Question 14

Criteria for prescribing an Adrenaline Pen:

Answer 14

History of Anaphylaxis
Previous cardiovascular / Respiratory involvement
Evidence of airway obstruction
Poorly controlled Asthma requiring regular inhaled corticosteroids
Reaction to a small amount of allergen
Ease of allergen avoidance

Question 15

Common age to inhale foreign bodies

Answer 15

80% of FBA episodes occur in children aged under 3. Older children with learning difficulties are also at risk.