Download Croup + Stridor in Children

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,
glottis, subglottis, or trachea.
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Inspiratory stridor; laryngeal obstruction
Expiratory stridor; tracheobronchial obstruction
Biphasic stridor; subglottic or glottic anomaly
Symptom; not a diagnosis or disease
Causes:
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Croup- viral laryngotracheitis
Croup- recurrent or spasmodic
Laryngeal foreign body
Epiglottitis
Croup- bacterial tracheitis
Trauma
Retropharyngeal abscess
Definition:
• Croup: acute clinical syndrome with
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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
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;
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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:
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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
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Harsh Stridor
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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.
Croup; Summary:
• ABC
• Nebulised Adrenaline
• Oral Dexamethasone or Inhaled Budesonide