Croup

• What age is croup most prevelant in?

  6 months to 3 years
• When is croup uncommon?

  After the age of 6
• What sex is croup most common in?

  Males
• What causes croup?

  Viral infection of the voice box and windpipe
• What virus commonly causes croup?

  Parainfluenza virus
• What are some symptoms of croup and how may is present?

  Barking cough

  Sore throat

  Stridor

  Increased work of breath

  Coryzal symptoms

  Worse at night

  Sudden onset

  Generally unwell
• What does 'coryzal symptoms' mean?

  Cold-like symptoms
• What is the management of croup?

  Dexamethasone 0.15 mg/kg

  Oxygen therapy

  Minimise distress

  Westly croup score to identify severity
• How is croup NOT managed?

  No antibiotics

  No cough medicine

  No steam
• What does the Westly croup score take into account?

  Stridor

  Recession

  Air entry

  Cyanosis

  Consciousness level
• Fill in the blanks

  A) None

  B) Agitation

  C) At rest

  D) None

  E) Mild

  F) Moderate

  G) Severe

  H) Normal

  I) Decreased

  J) Severely decreased

  K) None

  L) Agitation

  M) At rest

  N) Normal

  O) Altered

  
• What is a Westley croup score of 0-3?

  Mild
• What is a Westley croup score of 4-6?

  Moderate
• What is a Westly croup score of 7-17?

  Severe
• How to manage croup with a Westley croup score of 0-3?

  Oral steroids:

  Dexamethasone 0.15 mg/kg OR prednisolone 1-2 mg/kg
• When would oral prednisolone be used to treat croup with a Westley croup score of 0-3?

  if Dexamethosone is not available
• How is croup managed with a Westley croup score of 4-6?

  Oxygen

  Oral dexamethasone (0.15 mg/kg)

  Observe
• How to manage croup with a Westley croup score of 7-17?

  Oxygen

  Oral dexamethasone (0.15 mg/kg)

  Nebulised budesonide 2 mg if cannot take oral steroid

  Nebulised adrenaline (0.5 ml/kg 1:1000) Max 5 ml
• What happens if initial management of croup with a Westley croup score of 7-17 has no improvement?

  Repeat adrenaline

  Nebuliser

  Call paeds teams

  Call anaesthetic team if intubation is required
• What is croup characterised by?

  Stridor
• What is stridor caused by?

  Combination of laryngeal oedema and secretions
• What causes the majority of croup cases?

  Parainfluenza viruses
• What is croup?

  A form of upper resp tract infection
• Who is croup mostly seen in?

  Infants and toddlers
• What season is croup most common in?

  Autumn
• What are some features of croup?

  Cough

  Stridor

  Fever

  Coryzal symptoms

  Increased work of breathing
• What are some of the characteristics of the cough in croup?

  Barking, seal like

  Worse at night
• What is the criteria for mild croup?

  Occasional barking cough

  No audible stridor at rest

  No or mild suprasternal and/or intercostal recession

  Child is happy and can eat, drink and play
• What is the criteria for moderate croup?

  Frequent barking cough

  Easily audible stridor at rest

  Suprasternal and sternal wall retraction at rest

  No or little distress or agitation

  Child can be placated and is interested in surroundings
• What is the criteria for severe croup?

  Frequent barking cough

  Prominent inspiratory strodor at rest

  Marked sternal wall retractions

  Significant distress and agitation

  Lethargy or restlessness

  Tachycardia with hypoxaemia
• What is lethary or restlessness a sign of?

  Hypoxaemia
• What are some factors for admitting a child with croup?

  Moderaate or severe corup

  < 3 months of age

  Known upper airway abnormalities

  Uncertainty about diagnosis
• What are some known upper airway abnormalities that may be a factor for admission for croup?

  Laryngomalacia

  Down's syndrome
• Why may the uncertainty about croup diagnosis lead to admission?

  Differential diagnosis
• What are some important differentials that may lead to admission due to uncertainty of diagnosis for croup?

  Acute epiglottitis

  Bacterial tracheitis

  Peritonsillar abscess

  Foreign body inhalation
• What is an investigation done for croup?

  Chest x-ray
• What may a chest x-ray show for croup?

  Posterior-anterior view will show: subglottic narrowing (steeple sign)
• What may a chest x ray show in acute epiglottitis?

  Lateral view: Swelling of the epiglottis (thumb sign)
• What is the steeple sign?

  Shown on posterior-anterior view of a CXR: Subglottic narrowing
• What is subglottic narrowing called?

  Steeple sign