A look at one of the most common and potentially concerning upper respiratory infections in children.
Host:
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Croup.mp3



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Tags: Airway, Infectious Diseases, Pediatrics





Show Notes
Background

* Croup is a viral infection starts in the nasal and pharyngeal mucosa but spreads to the larynx and trachea

* Subglottic narrowing from inflammation
* Dynamic obstruction
* Barking cough
* Inspiratory stridor

* Causes:

* Parainfluenza virus (most common)
* Rhinovirus
* Enterovirus
* RSV
* Rarely: Influenza, Measles

* Age range: 6 months to 36 months
* Seasonal component with high prevalence in fall and early winter
* Differential

* Bacterial tracheitis
* Acute epiglottitis
* Inhaled FB
* Retropharyngeal abscess
* Anaphylaxis

Presentation & Diagnosis

* Classically a prodrome of nonspecific symptoms for 1-3 days with low grade fevers, congestion, runny nose.
* Symptoms reach peak severity on the 4th day
* “Steeple sign” on Xray (subglottic narrowing) present in only 50% of patients with croup
* Assess air entry, skin color, level of consciousness, for tachypnea, if there are retractions / nasal flaring (if present at rest or with agitation) & coughing
* “Westley Croup Score” (https://www.mdcalc.com/westley-croup-score)

* Chest wall retractions
* Stridor
* Cyanosis
* Level of consciousness
* Air entry

Management

* Mild Croup

* Occasional barking cough, but no stridor at rest and mild to no retractions
* Tx: Single dose of dex

* Has been shown to improve severity and duration of symptoms
* Route is not particularly important, whether it’s PO, IV or IM
* Chosen route should aim to minimize agitation in the patient that might worsen their condition

* May be managed at with supportive care

* Humidifiers (NB: there isn’t good evidence supporting the use of humidifiers)
* Antipyretics
* PO fluids

* Moderate Group

* May have stridor at rest, mild-moderate retractions but no AMS and will not be in distress.
* Tx: Dex + Racemic Epinephrine

* Racemic epinpehrine will start to work in about 10 minutes
* Effects last for more than an hour

* Severe group

* Receives the same initial therapy as the moderate group with dex and race epi
* Pts with worrisome signs: stridor at rest, marked retraction, cyanosis and/or lethargy
* Heliox (a combinations of 70-80% helium + 20-30% oxygen) may be attempted...