Croup and Epiglottitis

Question 1

What is croup?

Answer 1

Viral URTI resulting in inflammation and subglottic oedema of larynx, trache and bronchi

Mainly cuased by parainfluenza virus
Commonly affects children 6 months- 6 years

Question 2

What are clinical features of croup?

Answer 2

History of coryzal symptoms
Harsh barking cough (seal-like) aorse at night
Hoarse voice
Stridor
Resp distress
Increased work of breathing

Question 3

How do you classify croup severity?

Answer 3

Mild- seal like barking cough with stridor
Moderate- sternal recession
Severe- intercostal recession, agitation and lethargy

Question 4

What is the management of croup?

Answer 4

Single dose oral dexamethasone 0.15mg/kg
Can trial nebulised adrenaline if severe

Can consider CXR- may have steeple or thumb sign

Question 5

When should someone be admitted with croup?

Answer 5

Moderate or severe croup
<3 months
Known upper airway problems
Uncertain about diagnosis

Question 6

What are features of epiglottitis?

Answer 6

Infection with inflammation of epiglottis causing airway obstruction
Used to be caused by H influenza B (rare due to vaccination programme) now most common due to strep

Question 7

What are the clinical features of epiglottiitis?

Answer 7

Usually affects children 2-7
Abrupt sore throat and odynophagia
Continuous stridor with drooling
Muffled Voice
Fever
Tripod position to aid breathing

Question 8

What is the management of epiglottitis?

Answer 8

Can consider CXR

Need urgent assistance
- do not examine throat due to risk of agitating child
- may require intubation to protect airway
-IV Cefotaxime or Cefuroxime