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Introduction
  • Croup (acute laryngotracheobronchitis) is one of the more common childhood respiratory illnesses.
  • Croup is a viral inflammation of the upper airway, larynx, trachea and bronchi.
  • Symptoms present generally worse at night, peaking usually around 2AM to 3AM.

Read the complete article; Croup in the Medical Library > Pathophysiology.

Clinical Presentation

Croup is a viral infection of the throat and trachea that causes some or all of the following:

  • Noisy breathing (stridor) – a high-pitched sound
  • Hoarse voice
  • Harsh- barking cough
  • Increased respiratory rate
  • Intercostal and supraclavicular recession
  • Tracheal tug
  • Nasal flaring
  • Fever
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • Steroids have been shown to decrease the severity of croup, reduce the length of hospital stay, need for nebulised Adrenaline and other interventions
  • Children with croup usually have a cold first; a runny nose, cough and slight temperature. The child then typically wakes during the night with a barking cough and difficulty breathing.
  • Do not delay transportation.
Management
Primary Care
Intermediate Care (EMT / Level 2)
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
  • Mild to moderate croup: Oral Prednisolone without the need to use nebulised Adrenaline.
  • Severe croup with signs of severe respiratory distress: Nebulised Adrenaline then  Prednisolone
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • If no improvement, reconsider diagnosis (consider acute upper airway obstruction).

References
References
Key Terms & Links
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