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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