Croup

Pulmonology

Clinicals - History

Fact Explanation
Non-specific respiratory symptoms Most of the time symptoms consist of abrupt onset rhinorrhea, sore throat and cough especially at night. Common in the age group of 3 months to 5 years , Non-specific respiratory symptoms
Most of the time symptoms consist of abrupt onset rhinorrhea, sore throat and cough especially at night. Common in the age group of 3 months to 5 years ,
Inspiratory stridor The inflamed and swollen trachea is narrowed immediately below the vocal cords. Inspiratory stridor
The inflamed and swollen trachea is narrowed immediately below the vocal cords.
Spasmodic croup (Recurrent croup) Recurrent symptoms of croup occurs due to non-inflammatory edema of the vocal cords. Spasmodic croup (Recurrent croup)
Recurrent symptoms of croup occurs due to non-inflammatory edema of the vocal cords.
Barking cough Due to the irritation of trachea and glottis. Barking cough
Due to the irritation of trachea and glottis.
Fever Generally low grade fever, may rarely exceed 40°C. Fever
Generally low grade fever, may rarely exceed 40°C.
Poor feeding Mostly in young children. Poor feeding
Mostly in young children.
Hoarseness of voice Edema of the trachea and the throat. Hoarseness of voice
Edema of the trachea and the throat.

Clinicals - Examination

Fact Explanation
Fever The child is febrile due to the infection. Fever
The child is febrile due to the infection.
Inspiratory stridor Inflammation leading to narrowing of the airway below the vocal cords. Inspiratory stridor
Inflammation leading to narrowing of the airway below the vocal cords.
Expiratory wheezing Usually mild. Expiratory wheezing
Usually mild.
Features of labored breathing Suprasternal, intercostal and subcostal recessions can be seen. Features of labored breathing
Suprasternal, intercostal and subcostal recessions can be seen.
Reduced air entry to the lungs Due to the narrowed airway. Reduced air entry to the lungs
Due to the narrowed airway.
Cyanosis Increased desaturated hemoglobin in the blood causes peripheral cyanosis, later leading to central cyanosis. Cyanosis
Increased desaturated hemoglobin in the blood causes peripheral cyanosis, later leading to central cyanosis.
Respiratory failure Due to the narrowed airway leading to labored breathing. Respiratory failure
Due to the narrowed airway leading to labored breathing.

Investigations - Diagnosis

Fact Explanation
None Croup is a clinical diagnosis. None
Croup is a clinical diagnosis.
Full blood count This helps to differentiate a viral etiology from a bacterial etiology. Full blood count
This helps to differentiate a viral etiology from a bacterial etiology.
X-Ray of the neck When there is a doubt in diagnosis, “Steeple sign” (pencil-point sign) might be visible on the X-ray, which refers to subglottic narrowing. X-Ray of the neck
When there is a doubt in diagnosis, “Steeple sign” (pencil-point sign) might be visible on the X-ray, which refers to subglottic narrowing.
Nasal swab and viral studies Not routinely done, but helps in determining the antiviral treatment. Nasal swab and viral studies
Not routinely done, but helps in determining the antiviral treatment.
Bronchoscopy To detect anatomical abnormalities in recurrent croup. Bronchoscopy
To detect anatomical abnormalities in recurrent croup.

Investigations - Management

Fact Explanation
Arterial Blood Gas Analysis (ABGA) If the patient deteriorates, ABGA helps to assess the acid base status and for the early detection of type two respiratory failure. Arterial Blood Gas Analysis (ABGA)
If the patient deteriorates, ABGA helps to assess the acid base status and for the early detection of type two respiratory failure.
Pulse oximetry Helpful in assessing the severity of the disease so to decide on treatment options. Pulse oximetry
Helpful in assessing the severity of the disease so to decide on treatment options.

Management - Supportive

Fact Explanation
Antypyretics As the child may be febrile. Antypyretics
As the child may be febrile.
Antibiotic treatment for secondary bacterial infection. Group A Haemolytic streptococci and staphylococci are known organisms. Antibiotic treatment for secondary bacterial infection.
Group A Haemolytic streptococci and staphylococci are known organisms.
Intravenous fluids Correct dehydration. Intravenous fluids
Correct dehydration.

Management - Specific

Fact Explanation
Oxygen 100% oxygen should be administered in severe croup. Oxygen
100% oxygen should be administered in severe croup.
Corticosteroids Oral (prednisolone or dexamethasone), nebulized (budesonide), or intravenous can be used.
It has anti-inflammatory action and reduces the edema of the air way.
Usual dose is 0.6 mg/kg with maximum dose of 10mg as a single dose.
Corticosteroids
Oral (prednisolone or dexamethasone), nebulized (budesonide), or intravenous can be used.
It has anti-inflammatory action and reduces the edema of the air way.
Usual dose is 0.6 mg/kg with maximum dose of 10mg as a single dose.
Nebulized epinephrine Reduces the laryngeal edema, stimulates the beta-2 adrenergic receptors and causes bronchial smooth muscle relaxation and bronchodilation. The action lasts only for short period of time, therefore repeated doses are necessary. Nebulized epinephrine
Reduces the laryngeal edema, stimulates the beta-2 adrenergic receptors and causes bronchial smooth muscle relaxation and bronchodilation. The action lasts only for short period of time, therefore repeated doses are necessary.
Inhaled ribavirin Ribavirin is an antiviral acting against Para influenza virus. This can be considered for immune compromised patients. Inhaled ribavirin
Ribavirin is an antiviral acting against Para influenza virus. This can be considered for immune compromised patients.
Heliox therapy This is a mixture of oxygen and helium. Whereas some studies have proven no benefit , other studies have proven a clear benefit with inhaled heliox. Heliox therapy
This is a mixture of oxygen and helium. Whereas some studies have proven no benefit , other studies have proven a clear benefit with inhaled heliox.

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