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Pediatrics > Croup > Flashcards

Flashcards in Croup Deck (25):
1

Definition

Inflammation of supraglottic tissues +/- tracheobrochial tree
Swelling of mucosa, thick/viscous/mucopurulent exudate->compresses upper airway

2

Etiolgy

Viral
Parainfluenza most commonly

3

Differential

Inhaled foreign body
Epiglottitis
Bacterial tracheitis

4

Age commonly affected

6mo-3 years

5

Clinical features

- barking cough
- inspiratory stridor
- may have associated widespread wheeze
- increased work of breathing
- may have fever, but no signs of toxicity
-may or may not have wheeze, hoarse voice

6

Signs (3 S's)

Stridor
Supraglottic swelling
Seal bark cough

7

Assessment core

Minimal examination
Do not examine throat
Do not upset child

8

Recurrent croup- risk

Supraglottic stenosis
Down syndrome
Previous admission for severe

9

Features used to identify severity

Behaviour
Stridor
Respiratory rate
Accessory muscle use
Oxygen

10

Severity assessment- mild

Normal behaviour
Barking cough, stridor only when active/upset
Normal RR
No accessory
No oxygen required

11

Severity assessment- moderate

Some/intermittent irritability
Some stridor at rest
+RR, tracheal tug, nasal flaring
Mod chest wall retraction
No oxygen

12

Severity assessment- severe

+Irritability, lethargy
Stridor at rest
++/-ve RR
Tracheal tug
Nasal flaring
++chest wall retraction
Hypoxemia is late and significant sign of upper airways obstruction

13

Investiagtions

Investigations may not be done/necessary
Nasopharyngeal aspirate
CXR
Blood tests not usually indicated

14

Acute management

ABCD- get help
Minimal handling
Assess severity
If O2 needed, consider severe airway obstruction
Do not forcibly change childs position
Defer IV access
Avoid distressing further

15

Benefit of steroids

Decrease hospital stay
Decrease need for nebulised adrenline and other interventions

16

Management of mild-moderate

Prednisolone 1mg/kg, AND prescribe a second dose for the next evening.
OR
a single dose of Oral Dexamethasone 0.15mg/kg.

Observe for half an hour post administration. D/c once stridor free at rest

17

Management of severe, when improvement, then deterioration, no improvement

Nebulised adrenaline (1 mL of 1% adrenaline solution* plus 3ml Normal Saline, or 4ml of adrenaline 1:1000.)

(*some hospitals stock bottles of 1% adrenaline solution, often for ophthalmic use. If not available use 1:1000 vials)

AND

Give 0.6mg/kg (max 12mg) IM/IV dexamethasone, ?consider if can give orally

Improvement

If good improvement, observe for 4 hours post adrenaline. Consider discharge once stridor free at rest.

Improvement then deterioration

Give further doses of adrenaline. Consider admission/transfer as appropriate.

No improvement

Reconsider diagnosis. Acute upper airway obstruction.

18

When to consider consultation with local pediatric team

Severe airway obstruction
No improvement with adrenalin
Child has risk factors

19

When to consider transfer

No improvement with adrenalin
>2 doses neb adrenalin
Child requiring care above that which can be comfortably given at that hospital

20

Risk factors for severe croup

Downs
Neurological
Sub glottic stenosis
Previous admission with severe
uncommon->need to consider alternate diagnoses

Admit even if mild disease

21

How long after giving nebulised adrenalin do you need to observe patients

4 hours
Adrenalin can wear off, prior to effect of steroids and can then deteriorate

22

Patient advice overview

Signs and symptoms of croup
When to advise on return to hospital
When to advise calling an ambulance

23

Patient advice on signs and symptoms of croup

Hoarse voice
Barking cough
Stridor
Fever

24

Patient advise on when to return to hospital

Continuous stridor
Intercostal recession
Irritability

25

Patient advise on when to call the ambulance

Parents should be instructed to call an ambulance if:

The child's face is very pale, blue, or grey (includes blue lips) for more than a few seconds

The child is unusually sleepy or is not responding

The child is having a lot of trouble breathing (e.g., 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)

The child is upset (agitated or restless) while struggling to breathe and cannot be calmed down quickly

The child wants to sit instead of lie down

The child cannot talk, is drooling, or having trouble swallowing.

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