Updated: 12/25/2021

Croup

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  • Snapshot
    • A 5-year-old girl is brought to urgent care for difficulty breathing. For the past few days, she has had low-grade fevers, a runny nose, and a slight cough. On physical exam, she has a seal-like barking cough and audible inspiratory stridor. There is accessory muscle use with breathing. Her lung exam was normal without any wheezes. She is given the appropriate treatments for this condition, and the physician informs the family that this is likely viral and common in children.
  • Introduction
    • Clinical definition
      • upper respiratory infection characterized by barking cough
  • Epidemiology
    • Incidence
      • common
    • Demographics
      • children < 6 years of age
      • boys > girls
  • Etiology
    • Parainfluenza virus (most common)
      • a paramyxovirus
        • RNA virus
    • Influenza virus
      • orthomyxovirus
        • RNA virus
    • Pathogenesis
      • the virus causes inflammation of the upper airway
        • edema, epithelial necrosis, and infiltration of inflammatory cells
        • this causes narrowing of subglottic airway, resulting in stridor and increased work of breath
    • Associated conditions
      • bronchiolitis
  • Presentation
    • Symptoms
      • “seal-like” deep barking cough
      • difficulty breathing
      • sore throat
      • hoarseness
      • congestion
      • symptoms are worse at night
    • Physical exam
      • fever
      • inspiratory stridor
      • tachypnea
      • accessory muscle use
      • pulsus paradoxus with severe croup and upper airway obstruction
  • Imaging
    • Chest radiography
      • indication
        • all patients
      • findings
        • may show a steeple sign indicating subglottic narrowing
  • Differential
    • Acute epiglottitis
      • distinguishing factors
        • patients typically have muffled voice, drooling, high fever, and have dysphagia
        • a medical emergency
        • absence of barking cough
    • Tracheal and subglottic stenosis
      • distinguishing factors
        • can be congenital or from prolonged intubation in critically ill patients
        • inspiratory stridor
        • hoarse voice
        • absence of systemic symptoms including fever
  • DIAGNOSIS
    • Making the diagnosis
      • based on clinical presentation
  • Treatment
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • supplemental oxygen
          • hydration
    • Medical
      • single dose of steroids
        • indication
          • all patients
      • nebulized epinephrine
        • indications
          • moderate-severe croup
      • cool mist
        • indications
          • mild-moderate croup
  • Complications
    • Respiratory failure
    • Pneumonia
  • Prognosis
    • Most cases resolve without complications

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(M3.PD.16.72) A 4-year-old is brought into the emeregency room by his mother. The mother states that the child had a slight cough one week ago that has since worsened. The mother states the child's cough sounds like someone barking and states that he has also had mild fevers along with rhinorrhea. The patient's vitals are significant for a fever of 100.8 F, and his physical exam reveals inspiratory stridor. What is the most likely organism responsible?

QID: 103363

Parainfluenza virus

100%

(5/5)

Respiratory syncytial virus

0%

(0/5)

Adenovirus

0%

(0/5)

Ebstein barr virus

0%

(0/5)

Influenza A virus

0%

(0/5)

M 10 D

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(M3.PD.16.70) A 2-year-old boy in respiratory distress is brought to the emergency department by his parents. They state that approximately one hour after putting their child to sleep, a "hacking" cough was heard from his bedroom. After entering his room the parents state their child appeared to be in distress, making a high pitched noise with every breath. Beyond a runny nose for the past few days, the child has been healthy. He has no toys in his bed or access to any other small objects. Physical exam demonstrates a 2-year-old child in respiratory distress.

Which of the following choices is the proper management for this patient?

QID: 103361

Humidified oxygen and dexamethasone; discharge if the patient improves

11%

(1/9)

Discharge from the emergency department without treatment

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(0/9)

Dexamethasome, racemic epinephrine and observation for 4 hours; discharge if stridor remits

67%

(6/9)

Broncoscopy to remove a foreign body in the upper airway then discharge

11%

(1/9)

Empiric intravenous (IV) antibiotics, intubate and admission

11%

(1/9)

M 11 D

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