2. croup refers to a heterogeneous group of
mainly acute and infectious processes that are
characterized by a bark- like or brassy cough
and may be associated with hoarseness,
inspiratory stridor, and respiratory distress
spasmodic or laryngotracheobronchitis
2
3. Most common cause of upper airway acute
infection is virus , except ?
parainfuenza viruses (types 1, 2, and 3) 75% of
cases
Infuenza A is associated with severe
laryngotracheobronchitis
adenovirus, RSV , and measles
M.pneumoniae rare cause, mild
3
4. Most patient between 3 mo and 5 yr, with the
peak in the 2nd yr of life
more common in boys
most commonly in the late fall and winter
15% of patients have a strong family history of
croup
4
5. most common form of acute upper respiratory
obstruction
low-grade fever 1-3 days before the signs and
symptoms of upper airway obstruction become
apparent
rhinorrhea, pharyngitis, mild cough
barking cough, hoarseness, and inspiratory
stridor
5
6. child may prefer to sit up in bed or be held upright
Symptoms are characteristically worse at night
And aggravated by agitation and crying
resolve completely within a week
Other family members might have mild respiratory
illnesses with laryngitis.
6
7. hoarse voice
coryza
normal to moderately inflamed pharynx
slightly increased respiratory rate
Rarely respiratory distress
alveolar gas exchange ?
severe laryngotracheobronchitis is difficult to
differentiate from epiglottitis
7
8. children 1-3 yr of age
cause is allergic, psychologic. Viral in some cases
similar to acute laryngotracheobronchitis, except?
most commonly in the evening or nighttime, begins
suddenly
Child awake with a barking, metallic cough, noisy
inspiration, and respiratory distress
symptoms generally diminishes within several
hours
8
14. The mainstay of treatment for children with
croup is airway management and treatment of
hypoxia
Most children with either acute spasmodic
croup or infectious croup can be managed
safely at home
observation showed cold night air is benefcial,
a Cochrane review has found no evidence
supporting
14
15. Beneficial in mild, moderate, sever if given in the
first 3 days
single dose of 0.6 mg/ kg. a dose as low as 0.15
mg/kg may be just as effective
oral dose of dexamethasone as effective as
intramuscular. Nebulized budesonide
oral prednisolone is less effective
adverse effect candida albican laryngotracheitis in
patient who received dexamethasone, 1 mg/ kg/24
hr, for 8 days.
15
16. Nebulized racemic epinephrine is an
accepted treatment for moderate or severe
croup
decrease the laryngeal mucosal edema
dose of 0.25-0.5 mL of 2.25% racemic epineph-
rine in 3 mL of normal saline.
can be used as often as every 20 min
There is evidence that l-epinephrine (5 mL of
1:1,000 solution) is equally effective as
racemic epinephrine
16
17. Duration of activity < 2h
observe 2-3 h then discharge
17
18. Antibiotics are not indicated in croup.
Nonprescription cough and cold medications
should not be used in children < 4 yr
A helium-oxygen mixture (heliox) may be
considered in children with severe croup for
whom intubation is being considered
although the evidence is inconclusive
18
19. progressive stridor
severe stridor at rest
respiratory distress
hypoxia
cyanosis
depressed mental status
poor oral intake
the need for reliable observation
19
20. Does not require a radiograph of the neck
Steeple sign (PA)
Not specific
Does not correlate with disease activity
Considered after airway stabilization in
atypical presentation
20