Difference between revisions of "Croup"

(Diagnosis)
Line 15: Line 15:
  
 
===Croup Score===
 
===Croup Score===
Inspiratory stridor None 0 points  
+
*Inspiratory stridor
When agitated 1 points  
+
**None 0 points  
On/off at rest 2 points  
+
**When agitated 1 points  
Continuous at rest 3 points  
+
**On/off at rest 2 points  
 +
**Continuous at rest 3 points
 +
*Retractions 
 +
**None 0 points
 +
**Mild 1 points
 +
**Moderate 2 points
 +
**Severe 3 points
 +
*Air entry  Normal 0 points
 +
**Decreased 1 points
 +
**Moderately decreased 2 points
 +
**Severely decreased 3 points
 +
*Cyanosis
 +
**None 0 points
 +
**When crying 2 points
 +
**At rest 3 points
 +
*Alertness
 +
**Alert 0 points
 +
**Restless, anxious 2 points
 +
**Depressed 3 points  
 
   
 
   
 
+
'''Assessment'''
Retractions  None 0 points
+
*<2 Very mild  
Mild 1 points
+
*2-9 Mild to moderately severe  
Moderate 2 points
+
*>9 Severe croup
Severe 3 points
 
 
 
 
Air entry  Normal 0 points
 
Decreased 1 points
 
Moderately decreased 2 points
 
Severely decreased 3 points
 
 
 
 
Cyanosis  None 0 points
 
When crying 2 points
 
At rest 3 points
 
 
 
 
Alertness  Alert 0 points
 
Restless, anxious 2 points
 
Depressed 3 points
 
 
Assessment  
 
<2 Very mild  
 
2-9 Mild to moderately severe  
 
>9 Severe croup
 
  
 
==Work-Up==
 
==Work-Up==

Revision as of 15:57, 4 July 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

Croup Score

  • Inspiratory stridor
    • None 0 points
    • When agitated 1 points
    • On/off at rest 2 points
    • Continuous at rest 3 points
  • Retractions
    • None 0 points
    • Mild 1 points
    • Moderate 2 points
    • Severe 3 points
  • Air entry Normal 0 points
    • Decreased 1 points
    • Moderately decreased 2 points
    • Severely decreased 3 points
  • Cyanosis
    • None 0 points
    • When crying 2 points
    • At rest 3 points
  • Alertness
    • Alert 0 points
    • Restless, anxious 2 points
    • Depressed 3 points

Assessment

  • <2 Very mild
  • 2-9 Mild to moderately severe
  • >9 Severe croup

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