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Youtube vidoe http://www.youtube.com/watch?v=Qbn1Zw5CTbA Azza Elghonaimy 1 st May 2012

Croup. Youtube vidoe http://www.youtube.com/watch?v=Qbn1Zw5CTbA Azza Elghonaimy 1 st May 2012.

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Youtube vidoe http://www.youtube.com/watch?v=Qbn1Zw5CTbA Azza Elghonaimy 1 st May 2012

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  1. Croup Youtube vidoehttp://www.youtube.com/watch?v=Qbn1Zw5CTbA Azza Elghonaimy1st May 2012

  2. Case : A child with a loud barking cough :A 1 year old boy with a 2-day history of cough and noisy breathing .O/E:He has a loud barking cough . He has significant tracheal tug. and inspiratory stridor at rest.Temp.:38.1 C ,RR:34/min. His parents have tried steam but there has been no improvement.Q1:What important causes must we consider ?Q2:What therapies do we think may be effective?Q3:When should we refer to hospital?

  3. Differential diagnoses of acute stridor: • Croup :most common cause of acute stridor. • Acute epiglottitis ( rare) • Foreign body • Bacterial tracheitis (uncommon) • Angioneurotic oedema • Laryngomalacia. • Structural abnormalities (uncommon). • Diphtheria • Peritonsillar abscess • Retropharyngeal abscess • Smoke inhalation • Acute laryngeal fracture • Burns / thermal injury

  4. Croup : • Viral croup (Laryngotracheobronchitis): • Age 6 months -6 years • Insidious onset over a few days. • Lasts for 3 days on average . • Often worse at night . • Majority of cases will have mild illness . • Spasmodic Croup : • Recurrent short lived episodes particularly at nights. • Sudden onset and Without the typical coryzal prodrome. • History of Atopy and episodic stridor is common in children with • spasmodic croup.

  5. What therapies do we think may be effective?: • Simple measures ; • Keep the child and parents calm, sitting the child upright. • Throat examination can be dangerous . • Routine lateral neck xrays are no longer useful. • Investigations in acute presentation may include: • 1 -Neck xray: Steeple sign (PA view shows a narrowed column of subglottic air). • 2-CT. • 3.Pulse oximetry. • Recurrent Croup: • Bronchoscopy ;by chest physician /ENT surgeon.

  6. The modified Westley clinical scoring system for croup • Inspiratory stridor: • Not present - 0 points. • When agitated/active - 1 point. • At rest - 2 points. • Intercostal recession: • Mild - 1 point. • Moderate - 2 points. • Severe - 3 points. • Air entry: • Normal - 0 points. • Mildly decreased - 1 point. • Severely decreased - 2 points. • Cyanosis: • None - 0 points. • With agitation/activity - 4 points. • At rest - 5 points. • Level of consciousness: • Normal - 0 points. • Altered - 5 points. • Possible score 0-17: <4 = mild croup, 4-6 = moderate croup, >6 =severe croup

  7. Humidification; • Steam inhalation (placebo effect/risk of scalding) • Adrenaline : • Nebulised Adrenaline(2mg STAT) Adrenalin 5mls of 1:1000. • 0.4mg/kg Max 5 mg . • It is very effective in severe cases when intubation is considered. • It reduces mucosal oedema. • Duration of action is between 20 minutes and 3 hours. • Contraindicated in Fallots Tetralogy (Ventricular outflow obstruction)

  8. Steroids: • Dose :(0.15mg/kg) • Oral Dexamethasone OR Nebulised adrenaline. • Intubation : • Severe cases with worsening airway obstruction with signs of • exhaustion or impending respiratory failure . • Epiglottitis and Bacterial tracheitis.; • Specialist care ,ENT and anaesthetist. (Intubation and IV Antibiotics ) • Steroids and Adrenaline have Minimal effect .

  9. When to refer to Hospital: • Most cases of acute stridor are viral croup . • Mild croup : (no signs of respiratory distress)may be managed at home • , with parental observation.( parents to receive Clear instructions when • to return ). • Cases with significant respiratory distress ,stridor at rest or showing • atypical features • Low threshold for admission in children under age of 12 months. Emergency management in Primary care : If a child has croup that is severe or might cause complications then the child can be given either oral prednisolone 1-2mg/kg or oral dexamethasone (2mg/5mL oral solution) 150micrograms/kg, before transfer to hospital .

  10. Worrying signs in children with stridor : • High fever or signs of toxicity. • Rapid onset . • Drooling and dysphagia. • Muffield voice and quiet stridor. • Angioedema • Age less than 4 months. • Skin cavernous haemangioma. • Previous ventilation as a neonate

  11. References: • MRCPCH Mastercourse. • GP notebook. • Oxford handbook of Paediatrics • Local hospital guidelines • Thank you • Any question

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