Croup

Question 1

Croup defintion

Answer 1

An upper respiratory tract infection of the larynx, trachea and bronchioles most common in children aged 6 months to 6 years. The term croup refers to the clinical syndrome of a hoarse voice, harsh barking cough and inspiratory stridor.

Question 2

Pathophysiology of croup

Answer 2

• Viral infection of the larynx, pharynx, trachea and bronchi due to infiltration of WBC
  
  • Develops over a few days with concurrent rhinitis
  • Supraglottic airway inflammation cause of airway obstruction > inflammation leads to increase WOB and stridor due to turbulent airflow
  • Barking cough is cause by swelling in the supraglottic region
  • Symptoms generally last 3-5 days

Question 3

Croup: Mild symptoms

Answer 3

○ Happy child
○ Eating and drinking
○ Mild tachycardia and chest-wall retractions
Nil stridor at rest

Question 4

Croup: Moderate symptoms

Answer 4

○ Persistent stridor at rest
○ Chest-wall retractions
○ Use of accessory muscles
○ Tachycardia
Interactive child

Question 5

Croup: Severe symptoms

Answer 5

○ Fatigued
○ Worried child
○ Marked tachycardia
○ Restlessness, agitation
○ Decrease LOC
○ SpO2 <92% - hypoxia is a late sign which indicates life-threatening croup
○ Cyanosis
○ Poor muscle tone due to hypoxia and hypercapnia

Question 6

Croup management

Answer 6

Neb adrenaline 5mg/5ml
ICP: Dexamethasone 600mg/kg IV or OM