Croup or laryngotracheobronchitis
Upper airway infection obstructs breathing causing barking cough.
Syndrome characterized by;
Barking cough
Inspiratory stridor
Hoarseness
Sign of respiratory distress
Occurs due to varying degrees of larygeal obstruction.
Etiology
More common in male than female.
Occurs in late infancy and toddler period
Virus; parainfluenza viruses, Respiratory syncytial viruses, influenza virus, measles, adenovirus, Enterovirus
Bacteria (rarely)
Allergies
Reflux from stomach
Pathophysiology
Child infected; direct contact with person/ secretion of another infected person.
Infection begin Upper respiratory infection
Slowly spread down Respiratory tract
Inflammation/ congestion/ edema of mucosa and submucosa of larynx/trachea/bronchi
Associated with mucoid or mucopurulent discharge.
Exudation obstruct airway; producing inspiratory stridor and respiratory distress.
Clinical features
Child with croup present;
Barking cough
Respiratory distress;
Nasal flaring
Supraclavicular, epigastric and intercostal retraction. Use of accessory muscles of respiration.
Tachypnea
Inspiratory stridor
Hoarseness
Elevated temperature
Rapid pulse
Restless
Dysphagia
Severity of illness;
Leading to shock
Cyanosis
Impaired conscious
Diagnostic Evaluation
1. Child medical history (physical examination)
2. Neck and chest X rays
3. Blood tests; culture done to rule out diphtheria
4. Bronchoscopy
5. Pulse oximetery
Management
1. Monitor and facilitate respiration
a. Monitor respiration rate and depth
b. Observe sign of respiratory distress
c. Provide steam inhalation (older children)
d. Nebulize child with;
epinephrine
Corticosteroids; anti inflammatory action
e. Cool mist therapy
To reduce mucosal edema
f. Provide oxygen inhalation; respiratory distress
g. Encourage child to cough and deep breath
i. Chest physiotherapy and suctioning done.
2. For bacterial croup; antibiotics
3. Maintain hydration and nutritional requirement
Assess hydration status.
In shock; IV fluids
High calorie liquids given orally
Maintain I/O chart.
If cry; oxygen demand increase, to avoid this fowler's position given, facilitate respiration. Given familiar toys.
Promote rest
Support and educate parent.
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