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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
Croup (laryngotracheobronhitis) is the most common cause for stridor outside neonatal period.
Children's between 6 months and three years are most commonly affected, with peak in the second year of life.
The most commonest virus detected are parainfluenza, respiratory syncytial virus, human bocavirus and rhinovirus.
Clinical Feature
Typically begins with 1-2 days of nasal congestion, rhinorrhea, cough and low grade fever before onset of classic croup symptom.
Classic symptoms include a harsh cough often described as barking or like a seal, hoarse voice and stridor.
Symptoms are worse at night.
Duration of symptoms ranges from 3-7 days.
Diagnosis
Diagnosis is mainly clinical
Xray : Not necessary routinely. It is used for evaluation of other causes of stridor. Chest Xray may demonstrate subglottic narrowing called the steeple sign.
Assessment of severity
Mild | Moderate | Severe |
Occasional barking cough | Frequent barking cough | Frequent barking cough |
No audible stridor at rest | Easily audible stridor | Prominent inspiratory and occasional expiratory stridor |
Mild or no chest wall retraction | Chest wall or subcostal retraction at rest | Marked sternal retractions |
No agitation and distress | Little or no agitation | Agitation and distress |
Treatment
Adrenaline
Nebulized adrenaline is the main stay of treatment for moderate to severe croup patients with marked retractions and stridor at rest.
Adrenaline rapidly reduces the airway edema through vasoconstrictive alpha effect.
Clinical effect are seen in 10 min and last upto 1 hour.
Beta agonist should not be used in children's as stimulation of beta receptors will lead to vasodilation and worsen edema and exacerbate airway obstruction.
Dose : Adrenaline (1:1000) 0.05 ml/kg nebulised (Max: 5 ml)
Corticosteroids
All children's with croup benefits from corticosteroids
Corticosteroids improves symptoms by anti inflamamtory effect in the upper airway.
Dexamethasone is effectively parenterally and orally. Budensonide can be used alternatively.
Dose : 0.15 – 0.6 mg/kg PO/IM (Max: 10mg)
Budensonide : 2mg nebulised.
Heliox
Heliox may be a treatment option in serve refractory croup.
Criteria for Discharge from ED
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Updated on : 7/2/14
Reference
Tintinalli
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor