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Croup/Laryngotracheobronchitis

Croup, also known as Laryngotracheobronchitis, is the inflammation of the larynx, trachea, and bronchi. It's a type of URTI. It's usually caused by Parainfluenza virus. It typically affects children aged 6 months to 3 years.

“AP x-ray of the neck in a child with croup demonstrating the steeple sign; narrowing of the the trachea.” © Frank Gaillard CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Presentation

  • Barking cough

  • Inspiratory stridor

    • In children, the subglottic space is the most narrow part of their airway. In the presence of inflammation, there's significant narrowing of the airways, therefore resulting in a characteristic high-pitched inspiratory stridor.

  • Increased WOB

  • Hoarse voice

  • Fever


N.B. Inspiratory stridor = supraglottic obstruction. Expiratory stridor = infraglottic stridor (think asthma).


N.B. Extension of the inflammation into the bronchi can lead to wheezing, crackles, air trapping, and increased tachypnea, which may make on confuse it for asthma.


Management

  • Avoid agitating child with examination, procedures etc. as it can worsen the obstruction

  • Supportive fluids and rest

  • PO Dexamethasone 0.15mg/kg

  • Nebulised Budesonide

  • Nebulised Adrenaline




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