Croup review

Cause:

  • Viral infection, eg influenza, parainfluenza
  • The airway is swollen due to inflammation

Symptoms

  • Remember the S: seal bark cough, sound (hoarseness), stridor
  • Stridor defines severity
    – At agitation = moderate
    – Ar test = severe

Dx

  • Mainly clinical
  • If you do a neck X ray
    – AP: steeple sign
    – lateral: dilated hypopharynx

Ddx

  • Remember the AA
    – Anaphylaxis
    – Aspiration of foreign bodies
    – Airway infections eg bacterial tracheitis, epiglottitis
    – Airway compression eg  double aortic arch

Treatment

  • Anti-inflammatory – may take some time to work, so the cough and stridor may not stop immediately. It stops the inflammation from progressing
    – Dexamethasone, 0.15 mg/kg or 0.6 mg/kg PO once
    – Prednisolone, 1mg/k PO once for 2 days
    – Prednisolone has same efficacy as dexamethasone during the initial presentation
    as dexamethasone but re-attendance rate is higher for prednisolone, so need 2 doses
  • Epinephrine 1:1000, 5mL (= 5mg)
    – Only in severe resp.distress (i.e stridor at rest)
  • Other therapies
    – Heliox: alleviate the turbulent airflow
    – BiPAP
    – Intubation

What if it doesn’t respond to steroids?

  • Consider the ddx
  • bacterial tracheitis can present with croupy cough. But the kid is toxic looking, with painful swallowing.
  • Epiglottitis: toxic looking kid + painful swelling (normally with drooling) + muffled cough
    ** Can be difficult to be differentiated from tracheitis, cover with IV cefotaxime ! Cover for S.aureus and H.flu
  • Anaphylaxis and aspiration of foreign body

Reference:

Croup

http://bestpractice.bmj.com/best-practice/evidence/intervention/0321/0/sr-0321-i17.html

http://bestbets.org/bets/bet.php?id=2080

 

 

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