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Croup
Pediatric Diseases
| Question | Answer |
|---|---|
| Croup (Laryngotracheobronchitis) | General term used to describe the inspiratory barking sound associated with the partial airway obstruction that develops in laryngotracheobronchitis (subglottic croip) |
| Clinically the inspiratory sound heard in croup is also called.. | inspiratory stridor |
| Laryngotracheobronchitis (LBT) is used as a | synonym for "Classic" subglottic croup |
| LBT is an | inflammatory process that causes edema and swelling of the mucous membranes |
| LBT causes airway obstruction from tissue swelling just.. | below the vocal cords |
| A VIRAL Infection | that involves the upper and lower respiratory tract that causes subglottic edema |
| Etiology | Caused by Parainfluenza virus 1, 2, 3, transmitted by aerosol droplets |
| Patient Assessment (Information Gathering) | Primary Assessment |
| Past Medical History | Recent cold that developed gradually into a barking cough over 2-3 days, most common in the fall and winter |
| Cough | Barking, Hoarse voice |
| Appearance of the chest | Use of accessory muscles during inspiration, substernal and intercostal retractions |
| Respiratory Pattern | Tachypnea |
| Color | Cyanosis |
| Breath Sounds | Diminished, Inspiratory stridor |
| Physical Appearance | Age - 6 months to 6 years, alert with some accessory muscle usage |
| Vital Signs | Increase HR, BP, Qt, low grade temperature |
| Secondary Assessment | Secondary Assessment |
| Lateral Neck X-Ray | Haziness in the subglottic area (below the glottis) steeple point, pencil point, picket fence, hour glass narrowing of the upper airway |
| Arterial Blood Gas (ABG) | Acute alveolar hyperventilation with hypoxemia |
| Treatment/Management (Decision Making) | |
| Mild Cases | |
| Supportive Care | Temperature Control - cool environment Adequate hydration and humidification of inspired air |
| Closely Monitor | Vital signs Degree of Retractions Mental Status Ventilatory and oxygenation status |
| Oxygen Therapy | 30-40% |
| Cool aerosol mist | (Face mask, Tent) |
| Drug Therapy | Racemic Epinephrine (Micro-nefrin, Vaponephrine) Corticosteroids- For patients who DO NOT respond to cool aerosol and racemic epinephrine therapy |
| Severe Cases | Child with severe respiratory distress and/or Marked inspiratory stridor |
| Criteria for Intubation | Lethargic Severe stridor at rest Diminished breath sounds Extreme accessory muscle usage |
| Temperature control | cool environment |
| Adequate hydration and humidification of | inspired air |
| Transfer patient to | ICU |
| Sedate | if necessary |
| place on | T-Piece or CPAP |
| Criteria for extubation: | Child's condition is stable Air leak around the tube(swelling has gone down) |
Created by:
Max912