Croup
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Inflammation of the upper airways, the larynx, trachea and bronchi.
Aetiology
Viral: parainfluenza influenza virus, respiratory syncytial virus (RSV), adenovirus and measles.
Bacteria (rare): bordetella pertussis (whooping cough).
Fungal (very rare).
Pathophysiology
Inflammation of upper airway mainly larynx, trachea and bronchi caused mainly by invasion of viruses.
Immune response causes inflammation and mucus production.
Swelling and narrowing of airways which causes symptoms of barking cough, stridor and shortness of breath.
Risk factors
Age: common in children under the age of 5. Peak around the age of 6 months to 3 years old.
Exposure to infected individuals.
Background of asthma, allergies or other respiratory conditions.
Family history.
Weak immune system: those with chronic conditions such as diabetes, COPD, asthma, HIV/AIDs etc.
Smoking, air pollution and other environmental causes.
Sign and symptoms
Barking cough
Stridor
Hoarseness
In children you may observe symptoms of respiratory distress: tracheal tug, Intercostal recession and cyanosis
Diagnosis and investigations
Physical examination: general exam e.g. cardio, respiratory, GI examination, pulse oximetry, respiratory rate and capillary refil.
Chest X-ray not generally used because it can make a child more distressed.
Oxygen saturation measurement: if low O2 (<95%) child must be admitted.
Management
Steroids oral dexamethasone (0.15 mg/kg) and advice parents if stridor continues to go to hospital.
Example, Dexamethasone 2mg/5ml - 5 ml once only and stop 75ml.
Hospital admission: nebuliser or oxygen therapy might be commenced.
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