Episode 163.0 – Croup
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 Download One Comment 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...