Pedia Rotation Croup

PEDIA ROTATION
History
CROUP  Onset and progression of the illness
 Recent oral intake
INTRODUCTION
 Presence of dysphagia or drooling
Croup is a common acute upper respiratory illness seen in
infants and children, affecting about 5% of children in their  Choking episode
second year of life.  History of croup
 Underlying airway abnormalities
Most commonly, it is seen between the ages 6 and 36 months,  Previous intubations
although it can affect children older and younger than this as  Respiratory infections
well. It has a peak incidence in the fall and early winter, and is A recent history of viral upper respiratory infection (URI) can be
generally considered a mild, el-limited illness, but can be reassuring when trying to make a diagnosis of croup
complicated by respiratory distress and upper airway
obstruction. Physical Exam
 Overall assessment of the child
PATHOPHYSIOLOGY o Vital signs
 Croup affects the upper airway and is also referred to o Comfortable
as laryngotracheitis, or an inflammation of the larynx o Working hard to breathe
and trachea. o Awake or sleepy
 Most commonly due to Parainfluenza virus which o Dehydrated
affects the nasal pharynx before spreading distally.  Thorough pulmonary exam
Other viral etiologies include o Abnormal sounds
o Respiratory syncytial virus  Stridor: Many children with mild
o Adenovirus croup will have stridor when they
o Enterovirus are upset, which will improve once
o Human bocavirus they have calmed down. Stridor at
o Influenza rest is concerning for more severe
 The inflammation causes narrowing of the larynx just disease
below the vocal cords, called the subglottic airway.  Barky cough
 The cartilage in this part of the airway forms a Investigations
complete ring, which restricts the airway’s ability to  Chest and neck x-rays and labworks are not routinely
expand when inflamed recommended, unless the diagnosis of croup in
 Inflammation in this area causes the distinctive barky uncertain
cough and stridor, which are hallmarks of the disease.  Neck x-ray may show subglottic narrowing, known as
a steeple sign
CLINICAL PRESENTATION
 Initial upper respiratory infection symptoms followed MANAGEMENT
by Appropriate management of croup depends on the severity of
o Fever the case
o Hoarseness Croup is graded using the Westley score, which categorizes
o Barky cough patients based on chest wall retraction, stridor, cyanosis, level
o Stridor: a high-pitched sound heard upon of consciousness, and air entry.
inspiration indicating some level of
Mild cases without respiratory distress or stridor at rest,
obstruction
Westley <2
 Symptoms wax and wane, often worst at night
 In clinic: Single dose of oral steroids, usually
 More pronounced when child is anxious or upset
dexamethasone
 Signs like the ones below are signs of severe airway  At home: supportive measures
obstruction
o Antipyretics
o Respiratory distress
o Oral hydration
o Hypoxia
o Humidity such as hot showers but studies
o Cyanosis
have not demonstrated efficacy
o Stridor at rest
Moderate to severe cases with presence of retractions or
DIAGNOSIS stridor at rest, Westley >3
Differential diagnosis of a child with stridor  Oral steroids, or IM/IV if indicated
 Croup  Nebulize racemic epinephrine which works to
 Angioedema: seen in allergic reactions decrease airway edema by causing vasoconstriction
 Epiglottitis of precapillary arterioles, leading to decreased
 Retropharyngeal abscess capillary pressure and fluid resorption
 Foreign body aspiration  Consider inpatient hospitalization if improvement is
 Inhalation injury not seen with these therapies or if a child has required
 Anatomic airway anomalies multiple doses of racemic epinephrine.
Evaluation for suspected croup should include thorough history  If there is evidence of impending respiratory failure,
and physical examination to exclude these less common ICU admission with intubation may be required, but
etiologies of stridor. this is seen in less than 1% of patients presenting with
croup
COMPLICATIONS
 Secondary bacterial infections
 Recurrent croup
 Most cases resolve without complications within 1-3
days

Pedia Rotation Croup

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