Croup Flashcards
(12 cards)
Key points for croup
Minimise distress to the child, as this can worsen upper airway obstruction
Involve senior staff early and consider transfer if concerns regarding worsening upper airway obstruction
For severe and life-threatening croup, use nebulised adrenaline and seek a skilled senior clinician for airway support
Less severe cases can be managed with corticosteroids alone
Def croup
Croup is inflammation of the upper airway, larynx and trachea, usually triggered by a virus, most commonly parainfluenza as well as other respiratory viruses including COVID-19 (apply appropriate infection control)
Epid for Croup
6mo - 6 yo
RF for severe croup
History of previous severe croup
Pre-existing narrowing of upper airways
Reduced airway tone due to pre-existing conditions eg trisomy 21, neuromuscular conditions
Young age: uncommon in under 6 months old, rare in under 3 months old. Consider alternative diagnosis
Examination findings consistent with croup
Barking cough
Stridor
Hoarse voice or cry
May have associated widespread wheeze
Increased work of breathing
May have fever, but no signs of toxicity
Croup severity
https://www.rch.org.au/clinicalguide/guideline_index/croup_laryngotracheobronchitis/
DDX croup
Anaphylaxis
Inhaled foreign body
Bacterial infection
Retropharyngeal abscess
Peritonsillar abscess (quinsy)
Bacterial tracheitis
Epiglottitis
Airway burns or trauma
Ix for croup
Croup is a clinical diagnosis. Investigations such as respiratory swab or nasopharyngeal aspirate, X-rays and blood tests are not indicated in typical presentations. Consider appropriate investigations if there is concern for differential diagnoses as above
mng croup
https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/guideline_index/Croup-diagram.png
Minimise distress to avoid worsening symptoms, minimise interventions including examination and investigation that are not going to impact acute management
Keep child with carers to reduce distress
Try to keep the environment quiet, moderate lighting
Children will adopt a position of comfort that minimises airway obstruction, do not change this
Supplemental oxygen is not usually required. If needed, manage as severe upper airway obstruction or consider alternative diagnosis eg anaphylaxis, asthma
Medication
Mild
Children with barking cough alone and no history of stridor do not require steroids
Consider oral steroids: dexamethasone 0.15 mg/kg oral or prednisolone 1 mg/kg oral if stridor present or if risk factors such as young age and ability to access urgent review
Moderate
Oral steroids: dexamethasone 0.15 mg/kg oral or prednisolone 1 mg/kg oral
Consider nebulised adrenaline if persistent or worsening symptoms
Severe
Senior clinician review. Manage in high acuity treatment area
Nebulised adrenaline and
Dexamethasone 0.6 mg/kg (max 12 mg) PO/IM/IV
Life-threatening:
Move to resuscitation area and involve senior staff
Nebulised adrenaline 5 mL of 1:1000
100% oxygen 15 L/min via non-rebreather mask
Prepare for intubation by experienced clinician (see Emergency airway management), consider croup endotracheal tubes if available
Dexamethasone 0.6 mg/kg (max 12 mg) IM/IV
Croup- when to consider consultation with paeds
Severe airway obstruction present
Child has risk factors or any doubt about diagnosis
Child less than 6 months of age
No improvement with nebulised adrenaline
Croup- when to consider d/c
Stridor free at rest
and
Minimum of 3 hours observation post nebulised adrenaline (if this has been required)
Which steroid is preferred in croup mng
Prednisolone 1mg/kg, AND prescribe a second dose for the next evening.
OR
a single dose of Oral Dexamethasone 0.15mg/kg.
- both first line but dexamathasone shows reduced readmission rates
