9 June 2014

Croup (Medical Students)

Assessment

History – 1 to 6 year old (usually a toddler) coryza and low-grade fever, followed by acute barking cough, hoarseness and stridor (harsh inspiratory sound cause by narrowing of the airways, esp. the sub-glottis), often presenting at night. Ask about difficulty with talking and feeding.

Clinical examination – child sits on mum’s lap (to calm the child). Do not examine the throat. Observe general condition (agitation), barking cough, stridor, recessions, tachypnoea. Cyanosis and drowsiness indicate sever hypoxaemia. Take temperature and pulse oximetry and heart rate.

Differential diagnosis includes (1) bacterial tracheitis (high fever); (2) epiglottitis (Hib vaccination) (high fever, drooling, absent cough); (3) FB inhalation; (4) anaphylaxis.

Management

Home if no significant distress or stridor at rest, and parents are informed and confident. Humidification is of unproven benefit. Antibiotics are not indicated (parainfluenzae and other viruses). Advise parents to observe child and seek medical attention if the condition deteriorates.

If stridor or respiratory distress are present – give steroids (oral dexamethasone or prednisolone, or nebulized budesonide). Reassess – admit to hospital if significant respiratory distress remains; also consider young age and lack of parental confidence.

If there is severe airway obstruction, give nebulized adreanline and oxygen. Discuss with anesthetist and ENT surgeon; may need tracheal intubation and ventilation.