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:
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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