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CROUP (LARYNGOTRACHEOBRONCHITIS) - Coggle Diagram
CROUP (LARYNGOTRACHEOBRONCHITIS)
Common Respiratory Disease
Mostly children between 6months-3years
Caused by Parainfluenza virus types 1 or 3
More common in boys (ratio of 1.4 to 1)
Hospital admissions peak September to December
Clinical features
Sudden onset of seal-like barking cough
Non-specific URT symptoms may have been present for 12-72 hours
Progressive airway obstruction can cause stridor/respiratory distress
Symptoms worse at night & increase with agitation
Examination
Frightening child causes agitation/worsening of symptoms
Take care & time during examination to minimise upset/agitation
Ensure child is seated comfortable in parent's lap
Do not reposition child from naturally adopted posture that is minimising airway obstruction
Categorize severity of symptoms
MILD- Seal-like barking cough but no stridor or sternal/intercostal recession at rest
MODERATE- Seal-like barking cough with stridor and sternal recession at rest but no/little agitation or lethargy
SEVERE- Seal-like barking cough with stridor and sternal recession associated with agitation or lethargy
IMPENDING RESPIRATORY FAILURE- Minimal barking cough, stridor harder to hear, chest all and abdominal movement, fatigue, pallor, cyanosis, tachycardia, decreased consciousness level, OVER 70 BREATHS PER MIN
DIFFERENTIAL DIAGNOSIS
Bacterial tracheitis
Epiglottitis
Foreign body in upper airway
Allergic reaction
Peritonsillar abscess
Angioneurotic oedema
MANAGEMENT - Mild illness
Prescribe single dose of oral Dexamethasone 0.15mg/kg to be taken immediately
Advise parents that symptoms usually resolve within 48 hours
Advise paracetamol or ibuprofen for fever & pain
Encourage regular fluids/continued breast-feeding
Advise continued breast-feeding
Advise parents to check child regularly, especially overnight
Advise regular fluids
Advise to take child to hospital if continuous stridor, skin between ribs is pulling in with every breath or child is restless/agitated
Worsening advice/advise ambulance if
Child is pale/grey/blue for more than few seconds
Unusually sleepy/unresponsive
Having difficulty breathing
Upset/agitated & cannot be calmed down
Unable to talk/swallow or is drooling
Consider need for hospital admission from primary care
Admit all children with features of moderate or severe illness or impending respiratory failure
Consider hospital admission if resp rate over 60 breaths per min or if high fever/toxic appearance
Consider factors that warrant lower threshold for hospital admission
CHRONIC LUNG DISEASE
CONGENITAL HEART DISEASE
NEUROMUSCULAR DISORDERS
IMMUNODEFICIENCY
UNDER 3 MONTHS
INADEQUATE FLUID INTAKE
NO WET NAPPY FOR 12 HOURS
SOCIAL FACTORS THAT MAY AFFECT A CARERS ABILITY TO LOOK AFTER A CHILD WITH CROUP
LONGER DISTANCE TO HEALTHCARE
IF/WHILE AWAITING HOSPITAL ADMISSION
Give controlled supplementary oxygen
Administer oral Dexamethasone
IF CHILD IS TOO UNWELL FOR ORAL MEDICATION- Give inhaled budesonide 2mg single dose or intramuscular dexamethasone 0.6mg/kg as a single dose
ARRANGE FOLLOW UP USING CLINICAL JUDGEMENT TO DETERMINE APPROPRIATE INTERVAL
SIGNPOSTING