Croup

Croup

1. Pathophysiology

   • Parainfluenza virus type I
   • Other
     • RSV (2nd), adenovirus and rhinovirus

2. Risk Factors

   • 6 months – 6 years
   • Fall and winter seasons

3. Essentials for Diagnosis

   • Inflammation of the larynx and subglottic airway

4. Presentation

   • Harsh “seal bark” cough
     • Especially noticeable in infants and young children
   • Inspiratory stridor and hoarseness
     • More notable in older children and adults
   • URI symptoms
     • HA, malaise, sore throat, runny nose, low-grade fever
   • Significant airway obstruction and respiratory distress

5. Diagnostics

   • CLINICAL Dx
     • Once epiglottitis and foreign body aspiration are ruled out
   • Frontal cervical radiograph (CXR)
     • Steeple sign
       • subglottic narrowing of airway

6. Prevention

   • Handwashing

7. Prognosis

   • Children
     • Children: most children have an excellent prognosis
   • Outpatient
     • Most cases can be managed with outpatient care; fewer than 2% of patients require hospitalization
   • Nebulized epinephrine and steroids
     • The use of nebulized epinephrine and steroids has markedly lowered the need to intubate many patients

8. Complications

   • Complications are rare but can occur in some cases - Hospitalization, secondary bacterial infection, ptx, otitis media, dehydration, lymphadenitits
   • Rare

9. Management

   • Mild
     • No stridor at rest, no respiratory distress
     • Supportive
       • Supportive: O2 therapy is <92%
     • Dexamethasone
       • Discharge following intervention
     • Discharge
       • Discharge following intervention
   • Moderate
     • Stridor at rest with mild to moderate retractions
     • Supportive
       • O2 therapy if <92%
     • Dexamethasone
       • Dexamethasone (provides relief after 6 hours of single dose)
     • Nebulized epinephrine
     • Observe
       • Observe for 3-4 hours after intervention
   • Severe
     • Stridor at rest with marked retractions
     • Supportive
       • O2 therapy if <92%
     • Dexamethasone
       • Dexamethasone (provides release after 6 hours of single dose)
     • Nebulized epinephrine
     • Hospitalization