Croup Flashcards
Define croup/laryngotracheobronchitis
Common respiratory disease of childhood, characterised by sudden onset of a seal-like Barky cough, often accompanied by stridor, voice hoarseness, and respiratory distress
What are the causes of croup
Parainfluenza virus type 1 or 3
Influenza A and B
Adenovirus
RSV
Metapneumovirus
What are the risk factors for croup
Age 6 months to 6 years (peak 6 months - 3 years)
Autumn season
Male sex
What are the symptoms of Croup
(Prodrome of coryza, non-barky cough, mild fever)
Distinctive seal-like barky cough
- increases with agitation
- worse at night
- Abrupt onset
Hoarse voice
Fatigue, lethargy
What are the differentials for croup
Bacterial tracheitis
Epiglottitis
Foreign body in the upper airway
Retropharyngeal abscess
Angioneurotic oedema
Allergic reaction
Laryngeal diphtheria
What are the signs of croup on examination
Respiratory exam
Pallor, cyanosis (hypoxia)
Reduced level of consciousness (Hypercapnia)
Respiratory distress
persistent agitation
Asynchronous chest well and abdominal movement
What investigations are needed for croup
Largely clinical diagnosis
1. A-E (Must look at sats)
2. Resp. + cardio exams
3. Consider CXR to rule out epiglottitis or bacterial tracheitis
What is the management for croup and what features suggest need for admission
- Assess severity (A-E + resp. exam)
- Single dose oral dexamethasone 0.15mg/kg to all children regardless of severity
- If unstable - high-flow oxygen and nebulised adrenaline
Admit if:
- moderate or severe group
- <6 months
- known upper airway abnormalities e.g. Laryngomalacia, Down’s syndrome
- Uncertainty about diagnosis
What are the features of mild Croup and how is it managed
Seal-like barky cough with largely normal resp. exam
- Single dose oral dexamethasone 0.15mg/kg
- Supportive care
- Paracetamol/ibuprofen
- Regular fluid intake/continue breastfeeding
- Check on the child during the night
+ follow up
What are the features of moderate croup and how is it managed
Seal-like barky cough
Stridor and sternal recessions at rest
- Admit
- Single dose oral dexamethasone 0.15mg/kg
- Nebulised epinephrine
- Supportive care
- Paracetamol/ibuprofen
- Regular fluid intake/continue breastfeeding
- Check on the child during the night
Can discharge after 2-4 hours of observation following epinephrine administration
+ follow up
What are the features of severe croup and how is it managed
Seal-like barky cough with stridor and sternal recessions at rest
Agitation or lethargy
- Admit
- Single dose oral dexamethasone 0.15mg/kg
- Nebulised epinephrine
- Humidified oxygen 8-10L/min blow-by
- Supportive care
- Paracetamol/ibuprofen
- Regular fluid intake/continue breastfeeding
- Check on the child during the night
Can discharge after 2-4 hours of observation following epinephrine administration
+ follow up
What are the signs of impending respiratory failure in children with severe croup and how is it managed
Seal-like barky cough
Stridor and sternal/intercostal recessions at rest
Fatigue
Increasing upper airway obstruction
Reduced consciousness from hypercapnia
Signs of hypoxia (pallor or cyanosis)
Asynchronous chest wall and abdominal movement
Consider endotracheal intubation
Management the same as severe
Safety net for croup
Call the ambulance if:
Very pale, grey, or blue (including blue lips) for more than a few seconds.
Unusually sleepy or is unresponsive.
Having trouble breathing (for example, the belly is sinking in while breathing, or the skin between the ribs or over the windpipe is pulling in with each breath; the nostrils may also be flaring in and out).
Upset (agitated or restless) while struggling to breathe and cannot be calmed down quickly.
Unable to talk or is drooling, is having trouble swallowing, or want to sit instead of lie down.
What are the complications of croup
Bacterial tracheitis
Pneumonia
What is the prognosis of croup
Most children suffer a mild and self-limiting illness of short duration
Mild: self-limited without treatment but shorter time to resolution with dex
Moderate: Symptoms of obstruction may be stressful/frightening for family, but will resolve without significant complications
Severe: Prognosis is excellent with dexamethasone and nebulised epinephrine treatment
Impending respiratory failure: very rare
