Flashcards in Croup Deck (13):
What is it?
- = Laryngotracheobronchitis
- = Viral, respiratory infection of upper airway, larynx, trachea and bronchi
Age group of croup
- Uncommon <6 months, rare <3 months of age. Consider alternative diagnosis e.g. acute upper airway obstruction.
Most common causative organism of croup
- Viral: mostly parainfluenza virus, rarely RSV
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
Risk factors for croup
- Pre-existing narrowing of upper airways (e.g. Down syndrome, subglottic stenosis)
- Previous admissions with severe croup
Normal course of croup
- Peak of cough 2-3 days, normal course of whole croup is 7-10 days
What time of day is croup worse, and why?
- Cough worse at night, when air is cooler
What should you remember about examination in croup?
Children with croup should have minimal examination. Do not examine throat. Do not upset child further.
Roughly, what determines mild vs mod vs severe croup?
- Normal behaviour, RR, WOB, O2 sat
- Barking cough, stridor only when upset
- Inc RR, mod WOB (chest wall retraction, nasal flaring, tracheal tug), O2 sat ok
- Some stridor at rest
- Stridor always present at rest
- Inc/DEC RR, severe WOB (marked chest wall retraction etc)
- Hypoxaemia - late sign
DDx for croup
- Inhaled foreign body
- Bacterial tracheitis
When Ix for croup
- Most not needed, may worsen symptoms
- <6mo warrants Ix
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
○ D/C once stridor-free at rest
- Severe croup
○ Nebulised adrenaline + dexa IM/IV