lystn

Show Notes

Background

• Croup is a viral infection starts in the nasal and pharyngeal mucosa but spreads to the larynx and trachea
  • Subglottic narrowing from inflammation
  • Dynamic obstruction
  • Barking cough
  • Inspiratory stridor
• Causes:
  • Parainfluenza virus (most common)
  • Rhinovirus
  • Enterovirus
  • RSV
  • Rarely: Influenza, Measles
• Age range: 6 months to 36 months
• Seasonal component with high prevalence in fall and early winter
• Differential
  • Bacterial tracheitis
  • Acute epiglottitis
  • Inhaled FB
  • Retropharyngeal abscess
  • Anaphylaxis

Presentation & Diagnosis

• Classically a prodrome of nonspecific symptoms for 1-3 days with low grade fevers, congestion, runny nose.
• Symptoms reach peak severity on the 4^th day
• “Steeple sign” on Xray (subglottic narrowing) present in only 50% of patients with croup
• Assess air entry, skin color, level of consciousness, for tachypnea, if there are retractions / nasal flaring (if present at rest or with agitation) & coughing
• “Westley Croup Score” (https://www.mdcalc.com/westley-croup-score)
  • Chest wall retractions
  • Stridor
  • Cyanosis
  • Level of consciousness
  • Air entry

Management