-Used to describe the inspiratory barking sound associated with the partial airway obstruction that develops in Croup (Laryngotracheobronchitis) subglottic croup.
- LTB: an inflammatory process that causes edema and swelling of the mucous membrane just BELOW the vocal cords
- -causes airway obstruction from tissue swelling
Croup (Laryngotracheobronchitis)
- Primarily a VIRAL infection
- Caused by Parainfluenza virus 1, 2, & 3, transmitted by aerosol droplet
Etiology of Croup (Laryngotracheobronchitis)
- Past medical history: recent cold that developed gradually into a barking cough over 2-3 days
- Cough: barking, hoarse voice
- Appearance of the chest: use of accessory muscles during inspiration, substernal and intercostal retractions
- Respiratory pattern: tachypnea
- Color
- Breath sounds: diminished, inspiratory stridor
- Physical appearance: age 6 months to 5 yrs, alert w/ some accessory muscle usage
- Vital Signs: increased HR, BP, QT, low grade temperature
Primary assessment of Croup (Laryngotracheobronchitis)
Secondary assessment found in Croup (Laryngotracheobronchitis)
Lateral Neck X-ray
ABG
- Haziness in the subglottic area, below the glottis
- steeple point
- pencil point
- picket fence
- hour glass narrowing of the upper airway
Lateral neck findings in Croup (Laryngotracheobronchitis)
Treatment and management of MILD cases of Croup (Laryngotracheobronchitis)
- Supportive care: temp control (cool environment), adequate hydration and humidification of inspired air
- Oxygen therapy 30%-40%
- Cool aerosol mist (face mask)
- Drug therapy
Drug Therapy - Croup
- Racemic Epinephrine (MicroNefrin, Vaponefrin)
- Corticosteriods for patients who don’t respond to cool aerosol and racemic epinephrine
Treatment and management of SEVERE cases of Croup (Laryngotracheobronchitis)
Child with SEVERE respiratory distress and or MARKED inspiratory stridor
- Temperature control
- Adequate hydration and humidification of inspired air
- Transfer patient to ICU
- Sedate patient if necessary
- Place on T-piece or CPAP
Criteria for intubation for Croup (Laryngotracheobronchitis)
- Lethargic
- Severe stridor at rest
- Diminished breath sounds
- Extreme accessory muscle usage
Criteria for extubation for Croup (Laryngotracheobronchitis)
- Child condition is stable
- Air leak around the tube (swelling has gone down)
Emergency caused by inflammation of the suprglottic region that includes the epiglottis, aryepiglottic folds, and false vocal cords that causes swelling just ABOVE the vocal cords
Epiglottitis
Bacterial infection cause by Haemophilus influenza B (gram negative) transmitted by aerosol droplets
Etiology of Epiglottitis
- Past medical history: sudden onset within 6-8 hrs
- Cough: muffled cough
- Appearance of chest
- Respiratory pattern
- Color
- Breath sounds: diminished, inspiratory stridor
- Physical appearance: 2-6 yrs old, lifeless, drooling, dysphagia, jaw jutted forward
- Vital signs: high fever, increased HR, BP, QT
Diagnosis made at bedside
Primary assessment of Epiglottitis
- 2 to 6 years of age
- Lifeless
- Drooling
- Hoarseness
- Inspiratory stridor
- Dysphagia
- Tongue thrusts forward during -inspiration
- Voice and cry muffled
- Jaw jutted forward
Physical appearance found in Epiglottitis
Secondary assessment of Epiglottitis
Lateral neck x-ray
ABG
CBC
- Haziness in the supraglottic area, supraglottic swelling above the glottic
- Thumb sign
Lateral neck findings in Epiglottitis
CBC findings in Epiglottitis
Elevated WBC, bacterial infection
Treatment and management of Epiglottitis
- Immediate placement of an artificial airway
- Transfer to ICU
- Sedate if necessary
- Place on T-piece or CPAP
- Oxygen therapy
- Drug therapy: Antibiotics
Criteria for extubation - Epiglottitis
- Childs condition is stable
- Swelling in the airway has diminished
Past medical history: history of ingestion
Color: pallor, cyanotic
Physical appearance
–varies according to substance
–pupillary reflex: dilated or constricted
Primary assessment of Pediatric Poisoning/Toxic Substance Ingestion
Secondary assessment of Pediatric Poisoning/Toxic Substance Ingestion
- CXR
- ABG
- Electrolytes
- Special tests
Special tests for Pediatric Poisoning/Toxic Substance Ingestion
- Information on the dose and type of poison ingested
- Toxicology screening
- Renal and liver function tests
- Glucose level
- Anion gap calculation
Treatment and management for Pediatric Poisoning/Toxic Substance Ingestion
- Supportive care
- -stabilization of cardiovascular and respiratory systems
- Decontamination
- MV for ventilatory failure
- Antidotes
- -acetylcysteine for acetaminophen
- -Narcan for narcotics
)-Past medical history; family history of CF
- Shortness of breath: dyspnea on exertion
- Cough: large amount of thick purulent secretions
- Appearance of chest
- Respiratory pattern
- Color
- Diagnostic chest percussion
- Physical appearance: small for age, malnutrition, barrel chest
- Vital signs
Primary assessment in Cystic Fibrosis (Mucoviscidosis
