Croup

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Croup

  1. 1. Dr. Zeeshan Ghani Pediatrics Department BBH Rawalpindi
  2. 2. CROUP
  3. 3. Croup: * Acute infectious disease * Barklike or brassy cough *Hoarseness, Inspiratory Stridor
  4. 4. Croup Syndrome 1-Laryngotracheobronchitis 2-Acute Epiglottitis 3-Acute infectious laryngitis 4-Spasmodic Croup
  5. 5. Laryngotracheobronchitis Etiology Parainfluenza virus 75% (type 1,2,3) Influenza A & B Adenoviruses RSV
  6. 6. Clinical Features: * Age 3m – 5 yr * Male * Winter * Rhinorrhea, pharyngitis, mild cough * Low fever
  7. 7. * Barking cough, hoarseness, stridor * Worse at night * Resolve completely within a week * Croup is clinical diagnosis * X-ray neck shows “steeple sign” (subglottic narrowing)
  8. 8. Treatment (Laryngotracheobronchitis ) Mist / steam therapy * Mostens airway secretions * Sooths inflamed mucosa provide comforts Nebulized epinephrine * 0.25 ml in 3 ml of normal saline every 20 min
  9. 9. Steroids are beneficial * Dexamethasone 0.6 mg/kg * Nebulized budesonide No antibiotics Hospitalized if * Progressive stridor * Stridor at rest * Respiratory distress * Cyanosis * Depressed mental status
  10. 10. Acute Epiglottitis: * Potentionally lethal condition * Acute fulminating course * High fever, sore throat, dyspnoea * Rapidly progressing respiratory obstruction * Toxic, dysphagia
  11. 11. * Laboured breathing * Drooling * Hyperextended neck * Rapidly increasing cyanosis * Coma
  12. 12. Diagnosis: * “ Cherry red” swollen epiglottis * X- ray neck lateral – swollen epiglottis (Thumb sign) * Lucocytosis
  13. 13. Treatment: * Medical emergency * Establish an airway * Nasotracheal intubation or tracheostomy * Oxygen * Ceftriaxone or cefotaxime * Ampicillin + salbectam
  14. 14. Acute infectious laryngitis: * Virususes cause most cases (Diphtheria is an exception) * Sore throat, cough * Hoarseness and loss of voice out of proportion to systemic features * Physical examination is unremarkable * Laryngoscopy shows edema of vocal cords and subglottis tissue
  15. 15. Spasmodic Croup: Age: 1-3 yr * Viral prodrome and fever in absent * Cause is viral or allergic * Attacks are sudden and at night * Child awakens with barking cough * Stridor and hoarseness * Improves within hours
  16. 16. Differential Diagnosis: 1-Bacterial tracheitis 2-Diphtheritic croup 3-Measles croup 4-Foreign body aspiration 5-Retropharyngel or peritonsillar abscess 6-Angioedema 7-Hypocalcemic tetany
  17. 17. Thank You

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