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Croup (laryngotracheobronchitis) : summarized


Croup (laryngotracheobronchitis)

Dr Tayyab Javed

Definition: infection of glottic and subglottic region.most common form of acute upper respiratory obstruction.
Etiology:Mostly viral , caused by parainfluenza virus.
Symptoms:initial upper respiratory tract infection symptoms like rhinorrhea,pharyngitis,cough,fever for 1-3days then barking cough,hoarseness,stridor
provoking factors:agitation,crying
Signs:
hoarse voice,coryza,inflammed pharynx,stridor and signs of respiratory distress in the form of increasing respiratory rate,nasal flaring,suprasternal,infrasternal recession,intercostal retraction.
Investigations:
croup is clinical diagnosis but AP-radiograph neck shows typical subglottic narrowing or steeple sign.
Differential diagnosis:
1.diptheria
2.measles
3.foreign body
4.retropharyngeal or peritonsillar abscess
5.angioedema

Treatment:
1.airway management most important 
   a.suctioning
   b.calm and pacify the child
2.breathing & Circulation
   a.chest rise
   b.respiartory rate monitoring
   c.pulse oximetry 
  d. P.R , pulse volume, CRT , and Blood Pressure
3.hypoxia treatment by oxygen inhalation
4. Nebulization with Epinephrine HCl  (0.5mL/Kg of 1:1000 solution diluted in 3ml Normal Saline )(with maximum dose as :
4Year or less > 2.5ml/dose
More than 4 yr 5ml/dose

If the Patients stridor worsens and pt. deteriorates such that there is CNS depress, bradycardia, hypotension , then endotracheal intubation is the last resort.

Give Oral steroids or I/M Steroid to all children with croup:
reduce inflammation,
Dexamethasone , dose :   0.6mg/kg/dose  Only once.
May be given orally or intramuscularly.

oral prednisolone(deltacortil) is less effective.

contraindictaions to steroids:
children with varicella or tuberculosis infection

discharging criteria:
1.no stridor at rest
2.normal pulse oximetry
3.normal level of consciousness
4.have received oral steroids

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