Medical/Surgical

Question 1

Croup - what is it?

Answer 1

a common viral inflammatory illness of the subglottic structures causing inspiratory stridor and barking cough

Question 2

Croup pathophysiology

Answer 2

virus causes swelling of the larynx and trachea causing airway narrowing and breathing difficulties

Question 3

Croup signs and symptoms

Answer 3

sudden onset
low grade fever
hoarse voice
inspiratory stridor
barking seal like cough
accessory muscle use
URTI symptoms 1-2 days prior
symptoms worst 3-7 days

Question 4

Croup age group

Answer 4

6mths - 5 years
(can be older or younger)

Question 5

Croup - do Children appear toxic (pale, febrile & poorly perfused)?

Answer 5

No

Question 6

Croup - Mild Signs & Symptoms

Answer 6

barking cough
nil or intermittent stridor
no cyanosis

Question 7

Croup - Moderate Signs & Symptoms

Answer 7

barking cough and any of:
* persisting stridor at rest
* possible cyanosis
* some tracheal tug & chest wall recession
* can be placated and interested in surroundings

Question 8

Croup - Severe Signs & Symptoms

Answer 8

• persisting/soft stridor at rest
• cyanosis
• marked trachael tug and chest wall recession
• palpable paradox (drop of >10mmHG SBP during inspiration)
• apathetic or restless

Question 9

Croup - Impending respiraty failure signs and symptoms

Answer 9

• Increasing upper airway obstruction
• fatigue
• sternal/intercostal recession (may diminish as child tires)
• asynchronous chest wall and abdominal movement
• hypercarbia (decreased LOC secondary to rising PaCO2)

Question 10

Croup - Mild Treatment

Answer 10

• no specific treatment required
• ascertain P5 exclusions
• determine disposition (Immediate referral to GP or Transport to ED)

Question 11

Croup - Moderate Treatment

Answer 11

• Oxygen
• ascertain P5 exclusions
• determine disposition (Immediate referral to GP or Transport to ED)

Question 12

Croup - Severe Treatment

Answer 12

• oxygen if indicated
• adrenaline
• minimise time on scene
• transport to ED

Question 13

Croup P5 exclusions

Answer 13

• initial moderate or severe presentation
• previous Hx of respiratory problems requiring intubation and/or ICU/HDU admission
• suspicion of epiglottitis (eg unimmunised)
• toxic appearance
• age <6mths or >6yrs
• possibility or suspicion of inhaled foreign body and/or allergy and/or anaphylaxis
• minimal or absent cough
• febrile (>38.5)
• acute onset of respiratory symptoms
• excessive drooling

Question 14

Asthma - What is it?

Answer 14

an obstructive respiratory disease characterised by airway inflmmation, bronchial hyperresponsiveness and intermittent airway narrowing.

Question 15

Asthma Pathophysiology

Answer 15

• immune system activated inflammatory mediators released causing inflammation and irritation of lower airway resulting in mucosal oedema causing turbulent air flow
• bronchoconstriction increases residual volume, PCO2, air trapping and alveolar pressure and reduces oxygen rich air to alveoli causing decreased blood oxygenation

Question 16

Asthma - mild/moderate signs & symptoms

Answer 16

• Can walk, speak whole sentences in one breath (for young children can move around and speak in phrases)
• SpO 2% > 94% room air
• Pulse rate < 100/min Adult and Paed
• PEFR >75% of predicted adult and > 60% Paed of predicted or best (if known) or cannot be Performed

Question 17

Asthma - severe signs & symptoms

Answer 17

• use of accessory muscles (neck or intercostal) or ‘tracheal tug’ during inspiration or subcostal recession (‘abdominal breathing’)
• Unable to complete sentences in one breath due to dyspnoea
• Obvious respiratory distress
• SpO 2% 90-94% room air
• Pulse rate 100-120/min Adult and 100-200/min paed
• PEFR 50-75% adult and 40-60% paed of predicted or best (if known) or cannot be performed