Show Notes
Background
Croup is a viral infection starts in the nasal and pharyngeal mucosa but spreads to the larynx and trachea
Subglottic narrowing from inflammation
Dynamic obstruction
Barking cough
Inspiratory stridor
Causes:
Parainfluenza virus (most common)
Rhinovirus
Enterovirus
RSV
Rarely: Influenza, Measles
Age range: 6 months to 36 months
Seasonal component with high prevalence in fall and early winter
Differential
Bacterial tracheitis
Acute epiglottitis
Inhaled FB
Retropharyngeal abscess
Anaphylaxis
Presentation & Diagnosis
Classically a prodrome of nonspecific symptoms for 1-3 days with low grade fevers, congestion, runny nose.
Symptoms reach peak severity on the 4th day
“Steeple sign” on Xray (subglottic narrowing) present in only 50% of patients with croup
Assess air entry, skin color, level of consciousness, for tachypnea, if there are retractions / nasal flaring (if present at rest or with agitation) & coughing
“Westley Croup Score” (https://www.mdcalc.com/westley-croup-score)
Chest wall retractions
Stridor
Cyanosis
Level of consciousness
Air entry
Management
Mild Croup
Occasional barking cough,