Test 5 Ch.43 Croup and Croup- Like Syndromes Flashcards by Kiesha Alexis

This a general term that is used to describe the inspiratory barking or brassy sound associated w/ a partial upper airway obstruction

croup

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What is the inspiratory barking sound that is heard in pt’s w/ a partial upper airway obstruction

inspiratory stridor

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Another term for croup is

laryngotracheobronchitis (LTB)

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Primarily affects the lower laryngeal area, trachea and ocasionally the bronchi the term

laryngotracheobronchitis (LTB) is used as a synonym for “classic” subglottic obstruction

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LTB is an inflammatory process that causes

edema and swelling of the mucous membranes

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What is the most common cause of croup or croup-like symptoms?

LTB

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This is a life-threatening upper airway obstruction caused by an invasive bacterial infection of the soft tissues of the trachea

Bacterial tracheitis

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Bacterial tracheitis is still considered to be

subglottic

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This is life-threatening emergency, inflammation of the supraglottic region. Includes the epiglottis, aryepiglottic folds and false vocal cords

Acute epiglottis

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Airway and obstruction caused by tissue swelling and mucopurulent membranous secretions below the vocal cords (SUBGLOTTIC)

Bacterial tracheitis

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Airway obstruction caused by swelling just above the vocal cords (SUPRAGLOTTIC)

Epiglottitis

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Airway obstruction caused by tissue swelling just below the vocal cords (SUBGLOTTIC)

LTB

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What virus causes LTB in most cases?

Parainfluenza virus

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Type 1 LTB is the most

common

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Type 3 is

less common

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Type 2 is

infrequent

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What are other viruses that LTB may be caused by (6)

influenza A and B
RSV
Herpes simplex virus
Mycoplasma pneumoniae
rhinovirus
adenovirus

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Influenza A affects more

kids

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Influenza B affects more

adults

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LTB is primarily seen in children

6 months to 5 years w/ peaking at 2nd year of life

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Which gender is affected more?

Boys

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LTB is slow and is most common during the

fall and winter

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What is helpful w/ diagnosis of LTB? (2)

pt’s clinical history
radiologic examination

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What commonly causes Bacterial tracheitis?

Staphylococcus aureus

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Other bacteria that may case BT (3)

- H. influenzae - Beta- hemolytic streptococcus - Streptococcus pyogens

_____________ _____________ has been implicated w/ increased frequency and is associated w/ **severe** BT

Moraxella catarrhalis

Rare gram-negative organism linked to BT include (2)

- Pseudomonas - Klebsiella spp

BT is more commonly seen in the

winter months

What gender is affected in BT?

Boys

The __________ _____ radiograph will rule out epiglottis

Lateral neck

What is the most definitive method to diagnose BT

Direct visualization via laryngobronchoscopy of the airway

What is Acute epiglottitis is almost always caused by

Haemophilus influenzae type B

How is epiglottitis transmitted?

via aerosol droplets

H. influenzae type B is still responsible for about...

25% of epiglottitis cases

Other bacterial now associated w/ AE include (3)

- H. parainfluenzae - Streptococus pneumoniae - group A S. pyrogens

What has also been associated w/ AE in immunocompromised pts? (2)

- Candida - Aspegillus

AE has no clear out geographic or

seasonal incidence

AE may develop in all age groups, most often occurs in

children 2 to 6 y/o

AE is usually ________

abrupt

In AE Inspiratory stridor is usually

softer and lower in pitch

AE in adults is typically seen in pts w/

neck trauma

Clinical manifestations of LTB,BT and AE

upper airway obstruction

Vitals signs (3)

- Increased RR - Increased HR - Increased BP

Chest assessment findings (3)

- prolonged inspiratory phase - diminished breath sounds - Inspiratory stridor

Lateral Neck Radiograph (3)

- haziness in the subglottic area (LTB & BT) - haziness in **supraglottic** area (epiglottitis) - classic "thumb sign"(epiglottitis)

Anteroposterior (AP) Neck Radiograph

steeple pint or pencil point narrowing of the upper airway (LTB)

Treatment is based on the cause of the

croup and croup-like syndrome

LTB uses a score table that measures the pts

stridor, retractions, air movement, color and level of consciousness

In sever BT, the administration of……. Are often required (3)

- IV antibiotics - admission of ICU for intubation - Vent support

The management of AE is

very specific

Once the diagnosis is suspected or confirmed by the lateral neck radiograph, an examination or inspection of the

pharynx and larynx is to be done **ONLY** in the operating room under general anesthesia

B/c hypoxemia and significant WOB is associated w/ LTB, BT, and AE, what tx may be required?

oxygen

Aerosolized Racemic Epi is given to children w/ LTB based on the LTB scoring system:

- age 3 to 5: consider racemic epi - 6 and greater: administer 0.5 mL in 3mL normal saline

What does racemic epi do (pharmalogic)

it is used for vasoconstrictie effect on mucosal edema

Pts who have LTB symptoms but have BT do not

generally improve w/ racemic epi

What steroid have been shown to reduce the severity and duration of LTB in pts w/ moderate to severe symptoms?

dexamethasone

What antibiotics are commonly prescribed for pts w/ AE (2)

- Ceftriaxone (Rocephin) - ampicillin/ sulbactam (unasyn)

What gas may be helpful in severe cases of LTB?

Heliox

Heliox is combined w/

80% of helium and 20% oxygen, which has a lower density than room air

Breathing helliox lowers the _______ throughout the breathing cycle, reducing the child's _____ w/ __________ obstruction and preventing fatigue

Raw; WOB; airway

Pts w/ this, intubation is frequently required to stabilize the airway

**Questions from the back** The onset of **LTB** is usually:

24 to 48 hours

What is associated with eppiglottitis? (Bacteria)

Haemophilus influenzae type B

What clinical manifestation is associated w/ LTB

High-pitched and loud inspiratory stridor

The signs and symptoms associated w/ epiglottitis usually develop within

2 to 4 hours

Which of the following gas values are associated w/ mild to moderate LTB or epiglottitis

- Decreased PaCO2 - Increased pH

Bacterial tracheitis is most commonly caused by

Staphylococcus aureus

Inspection for croup (3)

- cyanosis - use of accessory muscles during inspiration - substernal and intercostal retractions

With Epiglottitis the pt usually maintains limited airway by

Sitting up and leaning forward w/ the chin protruding

Having a pt with epiglottises lie down will cause complete

Airway obstruction within minutes

Test 5 Ch.43 Croup and Croup- Like Syndromes Flashcards

(70 cards)