Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 172 views

    Croup

    Uploaded by

    Fariezuan Hamid
    Croup (laryngotracheobronchitis) is a condition caused by obstruction of the larynx, commonly due to parainfluenza virus. It presents with a barking cough, stridor predominantly on inspiration, hoarseness of voice, and respiratory distress. Diagnosis is clinical but neck radiographs can show "steeple sign". Treatment involves corticosteroids, nebulized adrenaline for severe cases, and hospitalization for those with moderate or severe symptoms. Prognosis is usually good with resolution within a week, though complications can include respiratory or epiglottic swelling.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Croup

    Uploaded by

    Fariezuan Hamid
    172 views20 pages
    Croup (laryngotracheobronchitis) is a condition caused by obstruction of the larynx, commonly due to parainfluenza virus. It presents with a barking cough, stridor predominantly on inspiration, hoarseness of voice, and respiratory distress. Diagnosis is clinical but neck radiographs can show "steeple sign". Treatment involves corticosteroids, nebulized adrenaline for severe cases, and hospitalization for those with moderate or severe symptoms. Prognosis is usually good with resolution within a week, though complications can include respiratory or epiglottic swelling.

    Original Description:

    Croup in children

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Croup (laryngotracheobronchitis) is a condition caused by obstruction of the larynx, commonly due to parainfluenza virus. It presents with a barking cough, stridor predominantly on inspiration, hoarseness of voice, and respiratory distress. Diagnosis is clinical but neck radiographs can show "steeple sign". Treatment involves corticosteroids, nebulized adrenaline for severe cases, and hospitalization for those with moderate or severe symptoms. Prognosis is usually good with resolution within a week, though complications can include respiratory or epiglottic swelling.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    172 views20 pages

    Croup

    Uploaded by

    Fariezuan Hamid
    Croup (laryngotracheobronchitis) is a condition caused by obstruction of the larynx, commonly due to parainfluenza virus. It presents with a barking cough, stridor predominantly on inspiration, hoarseness of voice, and respiratory distress. Diagnosis is clinical but neck radiographs can show "steeple sign". Treatment involves corticosteroids, nebulized adrenaline for severe cases, and hospitalization for those with moderate or severe symptoms. Prognosis is usually good with resolution within a week, though complications can include respiratory or epiglottic swelling.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Acute Stridor

    Stridor
    - Harsh, vibratory sound produced when airway
    become partially obstructed, resulting in
    turbulence airflow in the respiratory passage.
    Ddx of acute stridor?
    Infective
    - laryngotracheobronchitis
    - epiglotitis
    - bacterial tracheitis
    - diphteria
    - paratonsillar abscess
    - retropharyngeal abscess
    Immune-mediated
    - angioedema
    - anaphylaaxis
    Foreign body
    Inhalational injury
    Acute
    stridor

    Fever No fever

    Mild High fever


    fever History of choking
    (>38.5) or allergy

    Throat normal Throat: grey Throat :bulging Throat: swollen Normal throat
    exudate pharynx epiglottitis

    Retropharyngeal *Acute Angioneurotic


    *Viral Bacterial Diphteriae Foreign
    abscess epiglottitis edema
    croup tracheitis body

    6m-4yrs Any age


    Dysphonia Urticaria
    <3yrs <2yrs 3-7 yrs Wheeze
    6m-2 1-2 Unimmunised Neck Sudden onset
    years years Bull neck hyperextended Drools
    Dysphagia Prefers sitting
    Croup
    Croup (laryngotracheobronchitis) is a
    condition due to obstruction of the
    larynx

    It is a clinical syndrome characterized by


    barking cough
    stridor
    hoarseness of voice
    respiratory distress of varying severity
    Epidemiology
    Affects children between 6months to
    6 years
    Peak incidence is between age 1 to 2
    years
    Boys > girls
    Aetiological agent
    Parainfluenza virus (74%)
    Respiratory syncytial virus
    Influenza virus
    Adenovirus
    Enterovirus
    Measles
    Mumps
    Rhinovirus
    Pathophysiology
    Viral invasion of laryngeal, tracheal & bronchial
    mucosa

    Inflammation, hyperemia, edema, epithelial


    necrosis

    Irritation Subglottic Vocal cord


    narrowing swelling

    Mobility of the vocal


    Cough Airway
    cords becomes impaired
    obstruction

    Stridor Hoarseness of
    voice
    Clinical Features
    Symptoms
    Late
    Early (12-72hrs)
    Barking
    Low gradecough
    fever
    Harsh
    Coryzalstridor,
    symptoms
    predominantly on
    inspiration
    Hoarseness of voice
    Start and worse at night
    Signs
    Tachypnea
    Tachycardia
    Respiratory distress
    Nasal flaring, head bobbing, grunting,
    recessions
    Central cyanosis, d/t severe hypoxemia
    Auscultation
    Reduced breath sound
    Expiratory rhonchi
    Croup Severity Assessment
    Mild Moderate Severe
    Behaviour Normal Some / Increasing
    intermittent irritability,
    irritability lethargy
    Stridor When active / Some stridor Stridor at rest
    upset at rest
    Respiratory Normal Tachypneic Markedly
    rate with tracheal increased or
    tug, nasal decreased
    flaring with tracheal
    tug, nasal
    flaring
    Accessory None or Moderate Marked chest
    muscle use minimal chest wall wall
    recessions recessions
    Oxygen Normal Normal Hypoxaemia
    saturation

    http://www.rch.org.au/clinicalguide/guideline_index/Croup_Laryngotracheobronchitis/
    Diagnosis
    Clinically
    Examine pharynx to exclude
    Acute epiglottitis
    Retropharyngeal abscess
    Neck radiograph exclude foreign
    body
    Investigation
    FBC lymphocytosis
    Pulse oximetry measure O2
    saturation
    Neck radiograph Steeple Sign
    ( laryngeal air column narrowing
    below vocal cord)
    Laryngoscopy exclude peritonsillar
    abscess
    Figure 2. Anteroposterior radiograph of the
    Figure 1. Normal anteroposterior upper airway of a patient with croup. The
    radiograph of the upper airway, with the subglottic tracheal narrowing produces an
    normal appearance of the subglottic region. inverted V appearance known as the steeple
    sign.
    Management
    Home admission
    Hospital
    Mild in severity
    Moderate, severe
    Ease of
    Toxic access to hospital
    looking
    Age oral intake
    Poor
    Parental
    Age understanding
    <6 months
    Unreliable caregivers at home
    Long distance from hospital
    Lack reliable transport
    MILD MODERATE SEVERE
    Outpatient In patient In patient

    Dexamethasone Dexamethasone Nebulised adrenaline


    Oral/parenteral Oral/parenteral 0.3- 0.5mg/kg 1:1000
    0.15kg/single dose 0.6mg/kg single dose
    May repeat at 12 & and
    24h and/or
    Dexamethasone
    Prednisolone Nebulised budesonide Parenteral 0.3-
    1-2mg/kg/stat 2mg stat 0.6mg/kg
    & 1mg 12hourly
    or if vomiting and

    Nebulised budesonide Nebulised budesonide


    2mg single dose only 2mg stat
    & 1mg 12hourly

    and
    No improvement/ Oxygen
    Improvement
    deterioration

    No
    Home Nebulised improvement/deterioration
    adrenaline Intubate & ventilate
    Consider IV fluids if poor oral intake
    Antibiotics not recommended unless
    Bacterial super-infection strongly
    suspected
    Patient is very ill
    Complications
    Respiratory arrest
    Epiglottitis (swelling of tissue over
    vocal cords)
    Atelectasis (collapse of lung tissue)
    Middle Ear Infection
    Bacterial tracheitis
    Pneumonia
    Meningitis
    Septic Arthritis
    Prognosis
    Resolves within 3-7 days
    Recurrent are frequent between 3
    and 6 years of age
    Viral croup is the commonest cause
    of acute onset of stridor
    However, other conditions need to be
    considered in patient presenting with
    stridor

    You might also like