Education

1. Epiglottitis and Croup
B
y
Singer-
Leshinsky
Stace
y
R-
PAC

2. La
ryngotrachea
I branc
h
itis
Vira
l
Crou
p
• Known
as
laryngotracheiti
s
or
laryngotracheobronchit
is
• Most
common
etiolog
y
is
viral•
Parainfluenza
virus,
adenovirus
,
RS
V

3. La
ryngotrachea
I branc
h
itis
Vira
l
Crou
p
• Leads to infection and inflammation of
the larynx and subglottic area
vocal cords
•
•
Decreased mobility of the
Frequently affects children

4. Viral Croup
Clinical Manifestations
•
•
•
•
•
•
•
Begins
with
respirator
y
symptom
s
Withi
n
2
days
progresse
s
to:
Hoarsenes
s
Barkin
g
Stridor
-
sea
l
like coug
h
Symptom
s
Fever
wors
e
at nigh
t

5. Vira
l
Crou
p
• Mild disease: occasional barking
cough, no strider at rest, mild to
no suprasternal retractions
• Moderate: frequent cough,
audible strider at rest, retractions,
• Severe: frequent cough,
inspiratory/expiratory strider,
retractions, decreased air entry,
distress, and agitation.

6. La
ryngotrachea
Croup-
Diagnosis
I branc
h
itis
• A/P neck x-ray:
subglottic
CBC might
narrowing
show
•
lymphocytosis-

7. Croup
Differentials
•
•
•
•
Diphtheria
Epig lottitis
Peritonsilla
r
absces
s
Inhalatio
n
injurie
s

8. Viral Croup•
Management
• Coo
l
air mist, stea
m
fro
coo
l
exposure
to
outdoo
r
air
•
•
•
•
Adequat
e
hydratio
n
Glucocorticoids
Racemic
epinephrine
Dexamethason
e
for severe
cases

9. Viral Croup•
Management
• Hospitalizatio
n
indication
s
,.
,.
.
,.
.
Dehydration-
Significant respiratory compromise
Signs of respiratory failure
•
•
Complication
s:
Prognosis:

10. Spasmodi
c
Crou
p
• No prodrome
syndrome.
of upper respiratory
•
•
•
•
Subglottic edema
Affects
Affects
individual at night.
children between 1-3 years
Managed at home

11. Epiglotitti
s
• The epiglottis
cartilaginous
covered with
membrane
is a
structure
mucous
• Epiglottitis is an
of
acute
the epiglottis
structures
inflammation
and pharyngeal
• Can be severe life
threatening disease

12. Epiglotittis
• Primarily
Presents
Etiology:
affects children 2-7 years.
more acutely in young children
• H. influenzae type B, also
group A S
pneumoniee,
H
S sureus, and
beta•
pereintluensee,
hemolytic streptococci .

13. Epiglotittis-
ClinicaI
Manifestations
• Tria
d
of
drooling,
dysphagia
,
and
distress.
High fever
Positioning
-
•
•
•
tripo
d
positio
n
Dyspnea
/
Inspirator
y
strider
/
voice
accessor
y
muscle use /
muffled
Brassy cough
•

14. Epiglottit
is
Diagnosi
s
• Lateral neck -
enlarged
edematous
epiglottis.
Laryngoscopy:
Direct inspection of
epiglottis under
controlled conditions
Leukocytosis
Blood cultures
positive
•
•
•

15. Epiglotittis
Differentials
•
•
•
•
Anaphylaxis
Croup
Retropharynge
al
Absces
s
Foreig
n
bod
y
obstructio
n

16. Epiglotittis
Manageme
nt
• Secure
airway
wit
h
endotrache
a
I intubatio
n.
Migh
t
need
cricothyroidotomy.
•
•
•
•
•
Child
should
sit uprigh
t
Humidifie
d
oxyge
n
Hospitalizatio
n
No
tongue
blade
s
IV
antibiotics:Ceftriaxone
(Rocephi
n)
cefotaxim
e
(Ceftin)
,
Ampicilli
n
wit
h
chloramphen
icol
•

17. Epiglotittis
Management
• Evaluate for extubation 24-48 hours
post intubation.
•
•
24-48 hours post extubation
Rifampin prophylaxis for 4days for
household contacts if: children in
household have not been vaccinated
with the entire series

18. Revie
w
1
• A 4 year old is brought to the Emergency
Room with her mother at 4am. Mother states
child is coughing funny. Child has a two day
history of an upper respiratory infection.
•
•
•
•
What is the differential diagnosis?
How would this child be treated?
When would this child be hospitalized?
What findings are expected on neck x-ray?

19. Review
2
• A 6 year old
female
is
brought
to the ED
by
her
father.
Father states
female
is
very
sick
.
She is
drooling
and has a high
fever.
•
•
Wha
t
Wha
t
is
the
differenti
al
diagnosis
?
are some
other
clinica
l
manifestation
s
that migh
t
be
expected?
•
•
•
How
would
Should
this
this chil
d
be
treated?
chil
d
be
hospitalized?
Wha
t
ray?
finding
s
are
expected
on
lateral
nec
k
x•
• is etiolog of