Croup

Question 1

Define Croup

Answer 1

Croup is an acute infective respiratory disease affecting young children
- URTI causing oedema in the larynx

Question 2

Croup common causative virus

Answer 2

Parainfluenza types 1 OR 3
Influenza
Adenovirus
Respiratory Syncytial Virus (RSV)

Question 3

Croup clinical presentations

Answer 3

• “Barking” cough, occurring in clusters of coughing episodes
• Hoarse voice
• Fever
• Stridor
• Increased work of breathing

Question 4

0-2 mild Croup score Mx

Answer 4

Single dose PO dexamethasone
150mcg per kg weight

Question 5

OONNI

Croup stepwise Mx

Answer 5

Oral dexamethasone
Oxygen
Nebulised budesonide OR IV dexamethasone if unable to tolerate oral
Nebulised adrenaline
Intubation and ventilation

Question 6

Define Westley Croup Score

Answer 6

provides a valid scoring system that helps to categorise children based on their presenting clinical features of Croup

Question 7

5 components, SARCO

Westley Croup Score components

Answer 7

1. Stridor
2. Air Entry
3. Retractions
4. Consciouness level
5. O2 sat.

Question 8

Croup Risk factors

Answer 8

• Male > Females
• Aged 6 months and 3 years
• Peak at 2 years
• Autumn & Spring

Question 9

Tachy RR for children

Answer 9

RR >60/minute age 0 to 5 months
RR >50/minute age 6 to 12 months
RR >40/minute age over 12 months

Question 10

Diagnosing a sick child

Answer 10

• Increased RR
• Floppiness
• Using of accessory muscles
• Dehydration: not wetting nappy for >12hours / looking inside the mucosa
• Feeding / eating
• Chest recession
• Drowsiness

Question 11

Croup Pathophysiology

Answer 11

Viral URTI which results in mucosal inflammation anywhere between the nose and trachea causing oedema in the larynx

Question 12

Who should be getting PO dexamethasone for croup

Answer 12

ALL children with croup

Question 13

Croup complications

Answer 13

• Lymphadenitis
• Otitis Media
• Dehydration, as a consequence of not being able to maintain fluid intake
  Rare:
• Bacterial superinfection resulting in pneumonia or bacterial tracheitis
  Extremely rare:Pulmonary oedema, pneumothorax

Question 14

Westley Croup Score classification

Answer 14

0-2 Mild
3-5 Moderate
6-11 Severe
12-17 Impending respiratory failure

Question 15

3-5 moderate croup Mx

Answer 15

1. PO dexamathasone 150mcg/kg
2. Observe for 4 hours
   - if partially better, observe and repeat PO dexamathasone 150mcg/kg after 12 hours
   - if NOT better admit to hosp

Question 16

6-11 Sever croup Mx

Answer 16

1. PO dexamethasone
2. Consider adrenaline
3. Consider intubation
4. Admit

Question 17

> 11 croup score Mx

Answer 17

1. 100% O2 + nebs adrenaline
2. Senior Anaesthetist

Question 18

Why is nebulised adrenaline used in croup

Answer 18

can be inhaled and directly targeting the airways

Question 19

Why is adrenaline used in croup

Answer 19

• Vasoconstriction
• Smooth muscle relaxation
• Rapid action