Croup

Question 1

XR findings

Answer 1

Steeple’s Sign (subglottic narrowing

Question 2

Signs of resp distress in kids

Answer 2

Nasal Flaring
Suprasternal Retractions
Abdominal Breathing
Intercostal Indrawing
Unable to Speak Full Sentences
Tripod Positioning
Lethargy/Somnolence
Drooling
Grunting
Tachypnea
Cyanosis
Fatigue

Question 3

Sx

Answer 3

6mo-5yrs
Usually viral season (parainfluenza in fall, RSV in winter)
Inspiratory stridor
Barking cough
Hoarseness

Question 4

Ix

Answer 4

Physical exam only

Question 5

How to assess severity of croup

Answer 5

Wesley Croup:
chest wall retractions
stridor
cyanosis
LOC
AE

Question 6

Management

Answer 6

Passive blow by O2
Severe croup: L-epi 5mls of 1:1000 nebs, repeat q2H
Dexamethasone 0.6mg/kg PO/ IM/ IV, max 10mg x 1 dose
Observe + consider admission if severe

Question 7

How to counsel parents

Answer 7

Usually due to virus
May get recurrence of sx
Effect of steroid will last 24-48hrs
Return if difficulty breathing, stridor at rest etc
FU w/ GP in 24-48hrs

Question 8

DDx

Answer 8

Anaphylaxis
FB - CXR
Bacterial tracheitis - XR of neck
Epiglottitis - drooling, throat pain
Retropharyngeal abscess