Croup Flashcards Preview

Paeds - Resp > Croup > Flashcards

Flashcards in Croup Deck (13):
1

What is it?

- = Laryngotracheobronchitis
- = Viral, respiratory infection of upper airway, larynx, trachea and bronchi 

2

Age group of croup

- Uncommon <6 months, rare <3 months of age. Consider alternative diagnosis e.g. acute upper airway obstruction.

3

Most common causative organism of croup

- Viral: mostly parainfluenza virus, rarely RSV

4

Features of croup

- Typically begins with coryza and URTI Sx (e.g. fever, rhinitis +/- cough) 
- Barking croupy cough
- Breathing difficulty + tachypnoea
- Inspiratory stridor
- Widespread wheeze
- Hoarse voice

5

Risk factors for croup

- Pre-existing narrowing of upper airways (e.g. Down syndrome, subglottic stenosis) 
- Previous admissions with severe croup

6

Normal course of croup

- Peak of cough 2-3 days, normal course of whole croup is 7-10 days

7

What time of day is croup worse, and why?

- Cough worse at night, when air is cooler

8

What should you remember about examination in croup?

Children with croup should have minimal examination. Do not examine throat. Do not upset child further.

9

Roughly, what determines mild vs mod vs severe croup?

Mild:
- Normal behaviour, RR, WOB, O2 sat
- Barking cough, stridor only when upset

Mod:
- Irritable
- Inc RR, mod WOB (chest wall retraction, nasal flaring, tracheal tug), O2 sat ok
- Some stridor at rest

Severe:
- Irritable/lethargic
- Stridor always present at rest
- Inc/DEC RR, severe WOB (marked chest wall retraction etc)
- Hypoxaemia - late sign

10

DDx for croup

- Inhaled foreign body
- Epiglottitis
- Bacterial tracheitis

11

When Ix for croup

- Most not needed, may worsen symptoms
- <6mo warrants Ix

12

Mx of mild, mod and severe croup

- Minimal handling
- IV access deferred
- No abx (viral), no antitussive (?sedation - can't assess)

- Mild croup at home: calm, paracetamol to settle
- Mild to moderate croup 
○ Prednisolone/dexa
○ D/C once stridor-free at rest 

- Severe croup 
○ Nebulised adrenaline + dexa IM/IV

13

D/C requirements for croup

1. 4h post-nebulised adrenaline and/or half an hour post oral steroid
2. Stridor free at rest