Croup

1. Parainfluenza virus type I
2. Other

   Annotations:

   • RSV (2nd), adenovirus and rhinovirus

1. 6 months – 6 years
2. Fall and winter seasons

1. Inflammation of the larynx and subglottic airway

1. Harsh “seal bark” cough

   Annotations:

   • Especially noticeable in infants and young children
2. Inspiratory stridor and hoarseness

   Annotations:

   • More notable in older children and adults
3. URI symptoms

   Annotations:

   • HA, malaise, sore throat, runny nose, low-grade fever
4. Significant airway obstruction and respiratory distress

1. CLINICAL Dx

   Annotations:

   • Once epiglottitis and foreign body aspiration are ruled out
2. Frontal cervical radiograph (CXR)
   1. Steeple sign

      Annotations:

      • subglottic narrowing of airway

1. Handwashing

1. Children

   Annotations:

   • Children: most children have an excellent prognosis
2. Outpatient

   Annotations:

   • Most cases can be managed with outpatient care; fewer than 2% of patients require hospitalization
3. Nebulized epinephrine and steroids

   Annotations:

   • The use of nebulized epinephrine and steroids has markedly lowered the need to intubate many patients

Annotations:

• Complications are rare but can occur in some cases - Hospitalization, secondary bacterial infection, ptx, otitis media, dehydration, lymphadenitits

1. Rare

1. Mild

   Annotations:

   • No stridor at rest, no respiratory distress
   1. Supportive

      Annotations:

      • Supportive: O2 therapy is <92%
   2. Dexamethasone

      Annotations:

      • Discharge following intervention
   3. Discharge

      Annotations:

      • Discharge following intervention
2. Moderate

   Annotations:

   • Stridor at rest with mild to moderate retractions
   1. Supportive

      Annotations:

      • O2 therapy if <92%
   2. Dexamethasone

      Annotations:

      • Dexamethasone (provides relief after 6 hours of single dose)
   3. Nebulized epinephrine
   4. Observe

      Annotations:

      • Observe for 3-4 hours after intervention
3. Severe

   Annotations:

   • Stridor at rest with marked retractions
   1. Supportive

      Annotations:

      • O2 therapy if <92%
   2. Dexamethasone

      Annotations:

      • Dexamethasone (provides release after 6 hours of single dose)
   3. Nebulized epinephrine
   4. Hospitalization