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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
- Primary Survey
- Do not forcibly change a child's posture; they will adopt the posture that minimises airway obstruction
- Conduct Vital Sign Survey, particularly respiratory rate and pulse oximetry
- Administer oxygen
- Be alert for rapid deterioration
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
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