Difference between revisions of "Croup"

(Source)
Line 1: Line 1:
==Epidemiology==
+
==Background==
* 3 mo - 3 yrs (6-24 mo common)
+
*Croup = laryngotracheobronchitis
* fall & winter
+
*Affects 6 mo-3 yr (peak in 2nd year)
* Parainfluenza (50%), RSV, adenovirus, influenza, measles, HSV, Mycoplasma pneumonia.
+
*Fall & winter
*In non-immunized, poss Diphtheria --> give Erythromycin IV & Diphtheria antitoxin
+
*Etiology
* 6pm to 6am
+
**Parainfluenza (50%), RSV, rhinovirus
* Spasmodic croup age 1-5yrs
+
***Consider diphtheria if not immunized
 +
*Must rule-out foreign body
  
 
==Diagnosis==
 
==Diagnosis==
#r/o Foreign Body
+
#1-2 day of URI followed by barking cough, stridor
#2-3 day hx URI, then abrupt onset barking cough
+
#Low-grade fever
#Inspiratory Stridor
 
#low fever 37.7 - 38.8
 
 
#NO drooling or dysphagia
 
#NO drooling or dysphagia
#lasts 3 - 5 days, up to 1 wk
+
#Duration = 3-7d, most severe on days 3-4
#Steeple sign on AP (25% epiglotitis can show this too)
 
  
 
==Work-Up==
 
==Work-Up==
#Consider CXR
+
#Consider CXR if concerned about alternative dx
 +
##Steeple sign on AP (not Sp, not Sn)
 
#Consider nasal washings for RSV, parainfluenza, influenza.
 
#Consider nasal washings for RSV, parainfluenza, influenza.
  
==CROUP SCORE==
+
==Treatment==
 +
#Steroids
 +
##Give to all pts with croup
 +
###Dexamethasone 0.15-0.6mg/kg PO/IM (max 10mg)
 +
#Epineprhine (nebulized)
 +
##Give for moderatate-severe cases
 +
#Do NOT give albuterol (may worsen edema (vasodilation))
  
*STRIDOR
+
==Disposition==
**0 None
+
#Consider discharge if:
**1 Only c agitation
+
##3hr since last epinephrine
**2 Mild @ rest
+
##Able to tolerate PO
**3 Severe at rest
+
##Nontoxic apperance
* RETRACTIONS
 
**0 None
 
**1 Mild
 
**2 Moderate
 
**3 Severe
 
* AIR ENTRY
 
**0 Normal
 
**1 Mild decrease
 
**2 Mod decrease
 
**3 Marked decrease
 
* COLOR
 
**0 Normal
 
**1
 
**2
 
**3 Cyanotic at rest
 
* LEVEL OF CONSCIOUSNESS
 
**0 Normal
 
**1 Restless when disturbed
 
**2 Restless when un-disturbed
 
**3 Lethargic
 
 
 
==MANAGEMENT (Viral)==
 
*<4: Mild
 
** Mist
 
** Outpt
 
*5-6: Mild-Mod
 
** Mist
 
** Racemic epi^
 
** Dexameth^^
 
** Outpt if (after 3hr OPs):
 
*** Improved in ED
 
*** >6 mo old
 
*** Reliable family
 
*** No rest stridor
 
*** Access to F/U
 
*** Benign PMH
 
*** VS nl
 
*7-8: Moderate
 
** Racemic epi^
 
** Dexameth^^
 
** Admit
 
*>9: Severe
 
** Racemic epi^
 
** Dexameth^^
 
** Intubtion?
 
** PICU
 
 
 
^Racemic Epi 0.25-0.75mg in 2.5ml NS
 
 
 
if 1:1,000 (L-epi) use 2.5-5.0mL (= 5mg)
 
 
 
May repeat Q20-30 min x 3
 
 
 
DON'T USE if Cardiac Muscular Outflow Obstruction or Tetralogy of Fallot.
 
 
 
^^Dexamethasone 0.6 mg/kg IV/IM/PO
 
^^^Intubation: Use ET tube 1-2 sizes smaller than usual (swelling)
 
 
 
==Spasmodic Croup==
 
===Background===
 
-presents suddenly, without URI prodrome
 
 
 
-often resolve spontaneously before ED c cold night air, shower water vapor.
 
 
 
===Treatment===
 
Outpt
 
*cool mist / cool air / shower vapor
 
*2- 4 ml Nebulized NS or
 
*Racemic Epi 0.25-0.75ml in 2.5ml NS
 
  
 
==Source==
 
==Source==
4/14/06 DONALDSON (adapted from Lampe, Rosen)
+
Tintinalli
  
 
[[Category:Peds]]
 
[[Category:Peds]]
 
[[Category:ID]]
 
[[Category:ID]]

Revision as of 05:05, 22 June 2011

Background

  • Croup = laryngotracheobronchitis
  • Affects 6 mo-3 yr (peak in 2nd year)
  • Fall & winter
  • Etiology
    • Parainfluenza (50%), RSV, rhinovirus
      • Consider diphtheria if not immunized
  • Must rule-out foreign body

Diagnosis

  1. 1-2 day of URI followed by barking cough, stridor
  2. Low-grade fever
  3. NO drooling or dysphagia
  4. Duration = 3-7d, most severe on days 3-4

Work-Up

  1. Consider CXR if concerned about alternative dx
    1. Steeple sign on AP (not Sp, not Sn)
  2. Consider nasal washings for RSV, parainfluenza, influenza.

Treatment

  1. Steroids
    1. Give to all pts with croup
      1. Dexamethasone 0.15-0.6mg/kg PO/IM (max 10mg)
  2. Epineprhine (nebulized)
    1. Give for moderatate-severe cases
  3. Do NOT give albuterol (may worsen edema (vasodilation))

Disposition

  1. Consider discharge if:
    1. 3hr since last epinephrine
    2. Able to tolerate PO
    3. Nontoxic apperance

Source

Tintinalli