7. Clinical features
Happy wheezer
Preceded by URTI, Mild to
mod. fever(101-2°F)
Gradual onset of wheezy
cough, dyspnea
Tachypnea interfere feeds,
apnea in very young infants
15. Course & Prognosis
Highest risk (cough &
dyspnea) – first 48 to 72 hrs
Death is due to
Uncompensated respiratory
acidosis
Apnea
Severe dehydration
16. Course & Prognosis
Risk factors for severe
disease- age <12 wk,
preterm birth, or
underlying comorbidity
such as cardiovascular,
pulmonary, neurologic, or
immunologic disease
18. Treatment options
available
1. Inhaled epinephrine: some clinical
improvement
2. Inhaled bronchodilators – no use
3. Inhaled anti-cholinergics- no use
4. Hypertonic saline nebulization- some
clinical improvement
5. Steroids- No role
6. Antibiotics – no role, Mycoplasma
suspected- Macrolides
7. Antiviral- Palivizumab, Ribavirin-
24. C/F
Upper respiratory tract infection-
rhinorrhea, pharyngitis, mild cough,
and low-grade fever for 1-3 days
Characteristic “barking” cough,
hoarseness, and inspiratory stridor-
worse at night and often recur with
decreasing intensity for several days and
resolve completely within a week
Agitation and crying- aggravate
Not ill looking
28. Treatment
Nebulized Adrenaline- moderate or
severe croup- used as often as every
20 min
Oral dexamethasone used a single
dose of 0.6 mg/kg, a dose as low as
0.15 mg/kg may be just as effective
Intramuscular dexamethasone and
nebulized budesonide have an
equivalent clinical effect
29. Complications
15% children with croup- complications
Hypoxia and low oxygen saturation only
when complete airway obstruction
imminent
Child who is hypoxic, cyanotic, pale, or
obtunded- immediate airway
management
Bacterial tracheitis in some
33. Croup vs
epiglottitis
Inflammation of LTB-
Caused by virus-
Parainfluenza
Usually mild
No fever at
presentation- non
toxic child
X ray neck AP-
Steeple sign
Treatment-
Nebulized
Inflammation of
epiuglottis- Caused
by bacteria-
H.influenzae
Serious illness
High fever at
presentation- toxic
child
X ray neck lateral-
Thumb sign
Treatment- may need