The assessment and management of croup (original) (raw)
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Croup - assessment and management
Australian family physician, 2010
Croup is a common childhood disease characterised by sudden onset of a distinctive barking cough that is usually accompanied by stridor, hoarse voice, and respiratory distress resulting from upper airway obstruction. The introduction of steroids in the treatment of croup has seen a significant reduction in hospital admissions and improved outcomes for children. This article discusses the key aspects of diagnosing croup and the evidence supporting the different treatment strategies. The assessment of airway, breathing and circulation, focusing on airway, is paramount in treating croup. However, it is important to take care not to cause the child undue distress. In mild to moderate croup, give prednisolone 1.0 mg/kg and review in 1 hour. In severe or life threatening croup, give 4 mL of adrenaline 1:1000 (undiluted) via nebuliser and send immediately to hospital via ambulance.
Updates in Diagnosis and Management of Croup
Journal of Pharmaceutical Research International
Croup is a common respiratory disease that affects 3% of children aged six months to three years. It represents 7% of annual hospital admissions for fever and/or acute respiratory disease in children under the age of five. Boys are more susceptible than girls to the condition, with an overall male/female predominance of 1.4/1. Viruses are detected in up to 80% of patients with croup with identifiable pathogens. The onset of symptoms is usually sudden and usually occurs at night: stridor, hoarse voice and respiratory distress are often seen due to upper airway obstruction. Croup is a clinical diagnosis, children with an uncertain diagnosis, anterior and lateral soft-tissue neck radiographs may be useful to support an alternative diagnosis. Management includes: general care, humidified air, heliox, corticosteroids, and epinephrine, Objective: This study aimed to discuss croup in terms of its etiology, pathogenesis, clinical features, diagnosis, assessment, and finally management.
Management of croup in children
2018
Laryngotracheobronchitis, commonly known as croup, is a respiratory illness, often mild, which occurs most frequently in children between six months and three years of age. It is characterised by a seal-like ‘barking’ cough, hoarseness of the voice and inspiratory stridor which is preceded by fever, rhinorrhoea and a non-specific cough. Respiratory distress and lethargy are uncommon exacerbations of croup which may be potentially life threatening. This article provides an overview of croup, including the epidemiology and clinical manifestations and the management thereof.
American family physician, 2011
Croup is a common illness responsible for up to 15 percent of emergency department visits due to respiratory disease in children in the United States. Croup symptoms usually start like an upper respiratory tract infection, with low-grade fever and coryza followed by a barking cough and various degrees of respiratory distress. In most children, the symptoms subside quickly with resolution of the cough within two days. Croup is often caused by viruses, with parainfluenza virus (types 1 to 3) as the most common. However, physicians should consider other diagnoses, including bacterial tracheitis, epiglottitis, foreign body aspiration, peritonsillar abscess, retropharyngeal abscess, and angioedema. Humidification therapy has not been proven beneficial. A single dose of dexamethasone (0.15 to 0.60 mg per kg usually given orally) is recommended in all patients with croup, including those with mild disease. Nebulized epinephrine is an accepted treatment in patients with moderate to severe c...
Croup: assessment and evidence-based management
The Medical journal of Australia, 2003
Croup affects about 2% of preschool-aged children every year. Most children have mild croup and are managed at home, often after review by a general practitioner, who may decide that a single dose of oral corticosteroid is indicated (eg, if a risk factor for hospital admission exists). A minority of children develop moderate or severe croup. They should be reviewed in an emergency department and may need hospital admission. More liberal use of systemic corticosteroids for croup (in both primary care and emergency department settings) has been associated with reduced rates of hospital admission, reduced admissions to the intensive care unit and a reduced need for endotracheal intubation. We discuss the assessment and evidence-based management of a child with mild croup presenting to a GP and a child with moderately severe croup presenting to an emergency department. We present a flow chart summarising an approach to assessing and treating croup in the emergency department.
Seminars in Pediatric Infectious Diseases, 1995
roup is an illness characterized by a narrowed airway below the larynx and in the trachea. It presents with hoarseness, a peculiar barking cough, and stridor. Early in the 20th century, infants with stridor were frequently afflicted either with laryngeN diphtheria or bacterial tracheitis in addition to common viral croup; morbidity and mortalitywere much greater with the first two of these entities~ But because diphtheria and bacterial tracheitis have become progressively less common, there has been comparatively little investigation ofvirat croup, except on how best to manage it. This article wilt review all aspects of croup, emphasizing the most recent developments regarding its management. Etiology A large number of infectious agents are capable of causing croup (Table 1). In an 11-year study conducted in a pediatric practice in North Carolina, researchers found that parainfluenza virus type 1 accounted for nearly 50% of croup cases, and that parainfluenza virus type 3 and respiratory syncytial virus each accounted for more than 10% of total cases. 1 Other viruses andMycoplasmapneumoniae each accounted for a smaller percentage of cases. Table 1 also lists the possible causes of bacterial croup, which is quite rare. The agents listed in the table usually are present as a result of superinfection. Indeed, the viruses that most often cause viral croup also are those most often recovered in cases in which bacterial superinfection has occurred. 2;3 'In cases of croup without bacterial superinfection, parainfluenza virus type I is also the most common cause of croup severe enough to require hospitalization. Parainfluenza viruses types 2 and 3~ influenza virus type A, respiratory syncytial virus, and adenovirus are recovered occasionally from patients hospitalized with croup. Howard et al4 suggest that influenza A virus may cause particularly severe forms of croup. However, I have never seen art infant or child with particularly severe forms of croup caused by influenza type A. In bacterial croup, Staphylococcus aureus is recovered most often from purulent subglottic secretions, followed by Streptococcus pneumoniae, Streptococcus pyogenes, and Hemophilus influenza type B. 2,5 More recently, Moraxella catarrhalis has been recovered from patients with bacterial croup, 6 but this remains a rare entity.
The Cochrane Library and the treatment of croup in children: an overview of reviews
Evidence-Based Child Health: A Cochrane Review Journal, 2010
Croup is an illness characterized by barky cough, stridor, hoarseness, and occasionally respiratory distress. It is a relatively mild and short-lived illness for the majority of children. However, a small proportion of children have moderate to severe symptoms and are at risk of hospital admission, and in the most severe cases, intubation.
Journal of Education and Teaching in Emergency Medicine, 2018
The management of recurrent croup in children
The Journal of Laryngology & Otology, 2013
To review the aetiology, investigation, diagnosis, treatment and clinical outcome of children with recurrent croup. Retrospective case note review of all children with recurrent croup referred to the otolaryngology service at our hospital from November 2002 to March 2011. Ninety children with recurrent croup were identified. Twenty-five children (28 per cent) had anatomical airway abnormalities, of which 16 (18 per cent) demonstrated degrees of subglottic stenosis. Twenty-three children (26 per cent) had positive microlaryngobronchoscopy findings suggestive of reflux. Eleven children were treated for gastroesophageal reflux disease, 10 (91 per cent) of whom responded well to anti-reflux medication (p = 0.006). No cause was identified for 41 (45 per cent) of the children; this was the group most likely to continue having episodes of croup at follow up. One death occurred in this group. Airway anomalies are common in children that present with recurrent croup. Laryngobronchoscopy allows identification of the cause of croup and enables a more accurate prognosis. In the current study, laryngobronchoscopy findings that indicated reflux were predictive of benefit from anti-reflux medications, whereas the clinical presentation of reflux was not. Routine measurement of immunoglobulin E and complement proteins did not appear to be helpful.