Croup Stridor in Children Caitriona Broderick Source PALS

Croup + Stridor in Children Caitriona Broderick Source: PALS Guidelines

Stridor An abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway at the level of the supraglottis, subglottis, or trachea. – – Inspiratory stridor; laryngeal obstruction Expiratory stridor; tracheobronchial obstruction Biphasic stridor; subglottic or glottic anomaly Symptom; not a diagnosis or disease Causes: – – – – Croup- viral laryngotracheitis Croup- recurrent or spasmodic Laryngeal foreign body Epiglottitis Croup- bacterial tracheitis Trauma Retropharyngeal abscess

Definition: • Croup: acute clinical syndrome with – – – – Inspiratory stridor Barking cough Hoarseness Variable degrees of respiratory distress Preceded by fever, coryza for 1 -3 days Symptoms often start and are worse at night Can deteriorate rapidly • Commonest Cause (95%): Acute viral laryngotracheobronchitis (viral croup) – Pathogens; Parainfluenza virus, RSV, adenoviruses – Peak incidence; 2 nd year of life – Most hospital admissions; 6 mths-5 years

Initial Management? ABC

• Responsiveness? • Suction secretions • Airway: • Chin lift or jaw thrust manoeuvre – Vocalisations – Patency; chest movement +/- abdominal movement, symmetry, recession – Listen for breathing sounds and stridor – Feel for expired air – Reassess after any airway manoeuvres • Oro or nasopharyngeal airway device • Intubation with senior help

Breathing: – Effort of breathing; • • Respiratory Rate Stridor Accessory muscle use Recession Wheeze Flaring of nostrils Grunting Gasping – Efficacy of breathing; • Chest expansion • Breath sounds; reduced/absent/ • Symmetry on ausculataion • Sp. O 2 • 10 -15 L/min; 100% O 2 • Sp. O 2 94 -98%

• Circulation: – – Heart Rate Pulse Volume Capillary Refill Skin Temperature • Disability: – Mental status/ conscious level – Posture – Pupils • Exposure: – Rash or fever • Fluid Bolus; 20 ml/kg of 0. 9% saline

Severe Respiratory Distress + Harsh Stridor + Barking Cough Nebulised Adrenaline – 400 mcg/kg 0. 4 ml/kg of 1: 1000 – With oxygen – Via Face mask – May need to be repeated

Oral Dexamethasone 150 mcg/kg Or Inhaled Nebulised Budesonide 2 mg • Both equally effective • May be repeated after 12 hours if clinically indicated • <5% require tracheal intubation; – Tachycardia, tachypnoea, chest retraction, cyanosis, exhaustion or confusion.

Croup; Summary: • ABC • Nebulised Adrenaline • Oral Dexamethasone or Inhaled Budesonide