see also: [[cough (paeds)]], [[Upper airway obstruction (paeds)]] ![[Pasted image 20240501000037.png]] > [!Key points] overview > - AKA Laryngotracheobronchitis > - inflammation of the upper airway, larynx, and trachea > - usually between age 6 months and 6 years > - older patients have bronchitis > - often worse at night > - **DDx** > - bacterial tracheitis > - epiglottitis > - retropharyngeal abscess > - [[inhaled foreign body]] > - [[Anaphylaxis]] > - tracheomalacia # Cause - virus, often parainfluenza - RSV - adenovirus - flu - bacterial croup is rare (consider bacterial tracheitis) - corynebacterium - S aureus - s pneumo - h flu - moraxella catarrhalis # Severity (RCH guide) > - loudness of stridor is not a good indicator of severity of obstruction. soft stridor in the presence of worsening clinical picture may be a sign of imminent airway obstruction > - it is not necessary to measure oxygen sats in children with mild to mod croup | | mild | moderate | Severe | | -------------------- | ---------------------------------------- | ---------------------------- | ------------------------------------------------------------ | | Behaviour | normal | intermittent mild agitation | increasing agitation, drowsiness | | stridor | no stridor, or only when active or upset | intermittent stridor at rest | persistent stridor at rest | | resp rate | normal | increased RR | marked ↑ or ↓ | | accessory muscle use | none or minimal | mod chest wall retraction | marked chest wall retraction | | O2 sat | | | **hypoxia is a late sign indicating life-threatening croup** | # Westley croup severity score can use in age ≤ 6 - LOC - 0 - normal, including sleep - 5 - disoriented - cyanosis - 0 - none - 4 - with agitation - 5 - at rest - stridor - 0 - none - 1 - with agitation - 2 - at rest - air entry - 0 - normal - 1 - decreased - 2 - markedly decreased - retractions - 0 - none - 1 - mild - 2 - moderate - 3 - severe | score | severity | description | | ------ | ---------------------- | -------------------------------------------------------------------------------------- | | 0 - 2 | Mild | occasional barking cough, no stridor at rest, mild or no retractions | | 3 - 7 | Moderate | freq barking cough, stridor at rest, and mild-mod retractions | | 8 - 11 | Severe | frequent barking cough, stridor at rest, marked retractions, significant distress | | ≥ 12 | impending resp failure | depressed LOC, stridor at rest, severe retractions, poor air entry, cyanosis or pallor | # Treatment - minimal handling to avoid worsening sx - usually supplemental O2 not required - steroids (0.6mg/kg dexamethasone severe; 0.15mg/kg mild-mod) +/- nebulised adrenaline as per flow chart - ==0.5mL/kg of 1:1000 (1mg/mL) up to 5mL (5mg) adrenaline== Q5 min if needed # Disposition - age <3 months admit - can go when stridor free at rest AND - ≥ 4 hours observation ost nebulised adrenaline or - 30 min post dose of oral steroids and adrenaline not required - consider longer period of observation if: - presents overnight - limited access to medical care - presents with stridor more than once during same illness - risk factors for severe croup