What are clinical features of Croup
- Barking Cough
- Inspiratory stridor
- Hoarse voice
- Increased work of breathing
- Agitation
- Symptoms often worse at night
- Fever or wheeze may be present
What is the expected course of CROUPWhat is the expected duration of croup?
3 - 7 days
How long do patients experience URTI symptoms for before barking cough?
1-2 days
How long do patients with a CROUP have a cough for
approx 3 days
When do CROUP symptoms peak ?
3-4
What are 5 risk factors for severe croup?
- Age < 6months
- Pre-existing airway narrowing/abnormality (tracheomalacia, Subglottic stenosis)
- Past Hx of severe croup
- Sudden onset/rapidly progressing symptoms
- Complex medical conditions or those that predispose the patient ot respiratory failure (Neuromuscular disorders, down syndrome)
What are some differentials for CROUP
- Foreign body airway obstruction
- Epiglottitis (Consider drooling or difficulty swallowing. Drooling without coughing is suggestive of epiglottits)
- Anaphylaxis
What are the 5 assessments to consider in CROUP
Behaviour
Accessory muscle use
Respiratory rate
Stridor
Sp02
(BARSS)
What is considered mild croup (BARSS)
B: Normal
A: None
R: Normal
S: >= 96%
S: Nil or on exertion
What is considered Moderate croup (BARSS)
B: Intermittent mild agitation
A: Moderate chest wall retraction
R: Increased
S: >= 96%
S: Intermittent at rest
What is considered Severe croup (BARSS)
B: Increasing agitation drowsiness
A: marked chest wall retraction
R: Marked increase (Decrease late sign)
S: < 96% late sign
S: Persistent at rest (Decreasing late sign)
What is the management for Mild Croup
- self care
- 150mcg/kg max 12mg
What is the pathophysiology of CROUP
- Viral pathogen colonizes nasopharyngeal mucosa
- Virus migrates and invades upper airway
- Host immune response release of Cytokines and migration of immune cells to site
- Damage to healthy cells within upper airways
- Increased permeability of blood vessels within the upper airways
- Fluid leak into laryngopharyngeal and/or tracheal interstitiums
- Trachea is narrowed and clogged
- Decreased diameter of trachea
- Turbulent airstreams
- Inspiratory stridor and barking cough
- Increased work of breathing to ventilate lungs
- Nasal flaring, chest-wall in-drawing, tachypnea, accessory respiratory muscle use
- Resp distress
- Type 1 respiratory failure
What is croup?
infection of the larynx, trachea, and bronchi (Laryngotracheobronchitis)
What age range is most common for croup
6months - 6 years (most common, not exclusive)
What are the care objectives for CROUP
- Identify severity
- Dexamethason for all cases
- Adrenaline for severe cases
- Identify appropriate disposition
- Mild
- Moderate
- Severe
