croup + stridor in children caitriona broderick source: pals guidelines
TRANSCRIPT
StridorAn abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway at the level of the supraglottis, glottis, 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; 2nd year of life– Most hospital admissions; 6mths-5years
• Responsiveness?
• Airway:– Vocalisations– Patency; chest movement
+/- abdominal movement, symmetry, recession
– Listen for breathing sounds and stridor
– Feel for expired air– Reassess after any airway
manoeuvres
•Suction secretions
•Chin lift or jaw thrust manoeuvre
•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• SpO2
•10-15L/min; 100% O2
•SpO2 94-98%
• Circulation:– Heart Rate– Pulse Volume– Capillary Refill– Skin Temperature
• Disability:– Mental status/ conscious
level– Posture– Pupils
• Exposure:– Rash or fever
• Fluid Bolus; 20ml/kg of 0.9% saline
Severe Respiratory Distress+
Harsh Stridor+
Barking Cough
Nebulised Adrenaline – 400mcg/kg 0.4ml/kg of 1:1000– With oxygen– Via Face mask– May need to be repeated
Oral Dexamethasone 150mcg/kg Or
Inhaled Nebulised Budesonide 2mg
• Both equally effective• May be repeated after 12 hours if clinically
indicated• <5% require tracheal intubation;– Tachycardia, tachypnoea, chest retraction,
cyanosis, exhaustion or confusion.