1
Q
What is croup?
In what ages is it common?
A
- Acute laryngotracheobronchitis w sub glottic inflammation and oedema.
- 80% cases URTI –> viral –> parainfluenza
- Occurs mostly in those between 6 months - 6 years, most common ages 1-2
- More common in males
- Peaks in late autumn
2
Q
What is the presentation of croup?
A
- Sudden onset of barking seal like cough w stridor (predominantly inspiratory), hoarseness
- Symptoms worse at night
- 12-48 hour history –> rhinorrhea, fever, non specific cough
- Be careful not to further agitate as can worsen
3
Q
What are the categories of croup?
A
Mild –> Barking cough w/o stridor. No recession, no agitation or lethargy at rest.
Moderate –> Barking cough w stridor and recession. No agitation or lethargy at rest.
Severe –> Barking cough w stridor and recession. Agitation and lethargy.
Impending RF –> Recession, fatigue, pallor, cyanosis, decrease level consciousness.
4
Q
What is the treatment for croup?
A
- All patients single dose dexamethasone. 0.15mg per kg body weight
- Commonly self limiting and symptoms resolves within 48 hours
Mild
- Can be treated at home. Paracetamol for fever. Increase fluids. Give parents advice if deterioration to seek advice.
- When mild admit to hospital when –> CHD, CLD, immunodeficiency, not coping well, inadequate fluid intake (no wet nappy for 12 hours or <75% normal), <3 months, live distance to any healthcare
- Advice –> go to hospital–> stridor heard continually, the skin between the ribs is pulling in with breathing, and/or the child is restless or agitated.
- Advice –> ambulance –> child pale/blue/grey (includes blue lips) > few seconds, unusually sleepy, trouble breathing e.g belly sinking in and nasal flaring, is upset (agitated or restless) while struggling to breathe and cannot be calmed down quickly, if they want to sit instead of lie down, and/or if they cannot talk, are drooling, or having trouble swallowing.
Moderate and severe
- Hospital, supplementary oxygen when severe and waiting
- Too ill for oral dexa then budesonide nebuliser 2mg or IM dexa
- Potential nebulised adrenaline –> w stridor, recession and agitation
- Supplemental O2 when needed –> 8-10L/min blow by
5
Q
What are the investigations for croup?
A
- Clinical diagnosis
- When xray anteropostero lateral neck x-ray –> steeple sign (narrow trachea). CI when ?epiglottis as neck manipulation can make worse
6
Q
What is acute epiglottitis?
A
- Cellulitis of the supraglottis that may cause airway compromise.
- Haemophilis influenza B most common cause
- Incidence decreasing in children as haemoinflu B vaccine but increasing adults.
- Strep pneumonia also cause
- Children 1-6 years, most common 2-3
7
Q
What is the presentation of acute epiglottitis?
A
- Acute onset high fever, sore throat and drooling (can’t swallow secretions).
- Stridor –> soft and continous
- Whispering
- Tripoding –> sitting up and leaning forward on outstretched arms to ease upper airway obstruction.
- In adults –> onset more gradual
8
Q
What are the investigations for acute epiglottitis?
A
- 1st line –> Lateral neck XR diagnosis (showing enlarged epiglottis thumb print sign) –> those not intubated
- 1st line –> Laryngoscopy diagnosis –> at same point as securing airway in those intubated
- Others –>blood cultures from the supraglottis or epiglottis –> causative organisms
9
Q
What is the management of acute epiglottitis?
A
- Senior help
- Provide oxygen. Don’t disturb child w oral examination or trying to gain IV access –> can worsen respiratory distress.
- 1st line –> secure airway –> Rigid laryngoscopy and intubation –> most children need intubation (11% adults). (Airway compromise and waiting for airway to be secured then nebulise adrenaline).
- THEN –> IV Ab –> cefotaxime and ceftriaxone
- Stable w/o airway compromise –> supplementary oxygen. Dexa ? Reduce inflamm.
- Once extubated and stable –> oral Ab –> amoxicillin
- Definitive treatment –> intubation (often not needed in adults) and IV antibiotics
Physician Associate
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