CROUP Year 4 Paediatrics Notes OmpathStudy

CROUP Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.1 / Agisa -- Slide 1 CROUP Dr. agisa kegode Slide 2 Inflammation involving the vocal cords and structures inferior to the cords is called laryngitis,laryngotachetitis,or laryngotracheobronchitis Inflammation superior to the vocal cords is called supraglottitis Croup-refers to a heterogenous group of mainly acute and infectious process that are characterized by a bark like or brassy cough and may be associated with hoarseness of voice,inspiratory stridor and respiratory distress Slide 3 Aetiology Viral agents account for most acute infectious upper airway disease-parainfluenza type 1,2 and 3 account for almost 75% of the cases. Other viruses include influenza A and B, adenovirus, Respiratory syntitial virus, and measles Bacterial agents include diphtheria, bacterial tracheitis and epiglottis Most children with croup are aged between 3 months -5 years with peak in the 2nd year of life Croup is a disease of the upper airway and alveolar gas exchange may remain normal Slide 4 Patients have rhinorrhea, mild pharyngitis,cough and low grade fever 1-3 days before signs and symptoms of upper airway obstruction appear. The child then develops the characteristic barking, hoarseness of voice and inspiratory stridor Hypoxia and alveolar gas exchange abnormalities will be seen if there is complete airway obstruction child who is hypoxic, cyanosis,pale,obtunded needs immediate airway support, Symptoms are worse at night, and recur with decreasing intensity, for several days then disappear completely within a week. Agitation and crying aggravate the symptoms Croup is a clinical diagnosis Radiograph of the neck may show =subglottic narrowing(steeple sign) on the postero-anterior view Slide 6 Tripod position Slide 7 Nebulised Racemic adrenaline -0.25ml -0.75 ml of 2.25% racemic adrenaline in 3 mls normal saline every 20 minutes(Not found in kenya) Nebulise with L-epinephrine 5 mls of 1:1000Give corticosterioids-Im dexamethasone 0.6mg/kg stat,nebulized budesonide, Humidified mists/steaming can be useful Slide 8 Acute epiglottitis(supraglottitis) It’s a dramatic,potentially lethal condition High fever,sore throat,dyspnea, and rapidly progressive respiratory obstruction Otherwise well child develops a sore throat and fevers and in a matter of hours appears toxic,swallowing is difficulty and develops respiratory distress. Drooling is present and the neck is hyperextendend in an attempt to try and maintain tha airway. The child may assume the tripod position-sits upright,leans forward with chin up and mouth open while bracing on the arms. Stridor is a late finding and indicates near complete airway obstruction. Barking cough of croup is rare, Usually no other family members are ill Slide 9 Diagnosis-visualize a large” cherry red “ swollen epiglottis by laryngoscoy. Anxiety provoking procedures should be avoided until the airway is secure Lateral neck xray shows “the thumb sign” Airway should be established in all patients regardless of the degree of respiratory distress(by nasotracheal intubation or tracheostomy Antibiotics should be given for epiglottitis-ceftriaxone,cofotaxim for 7-10 days(H- influenza is the most common organism) Slide 10 Thumb sign Slide 13 Acute bronchiolitis Predominantly a viral infection Respiratory synticytial virus is responsible for 50% of cases. Other agents include parainfluenza,adenovirus,mycoplasma and other viruses like human metapneumovirus Preceded by exposure to an older child with a rti within the previous week. Infant first has mild rti –with sneezing, and clear rhinorrhea,reduced appetite fevers, then gradually respiratory distress, ensures with paroxysmal wheezy cough,dypnea and irritability. The infant is often tachypneic, very small infants< 2 months or formery premature infants may have apnea. Most often there are no other symptoms like diarrhea or vomiting Slide 14 Treatment Give trial of bronchodilator-nebulized salbutamol Nebulised adrenaline Add on ipratropium if infant has trachea or bronchieomalacia Nebulized hypertonic saline(3% saline) 3 mls)\nTrial of steroids in moderate -severe cases and children with history of atopy Oxygen is indicated in all infants with hypoxia. ribavirin –for infants with congenital heart disease or chronic lung disease Can recur Appox 60 % of infants who wheeze will stop wheezing Prevention-palivizumab-a monoclonal antibody to RSV –for children < 2 years with chronic lung disease or in prematurity Slide 15 Acute bronchitis Commonly preceded by a viral rti Rhinitis,low grade fevers,,harking cough,chest pains The entire episode lasts around 2 weeks, Clinician must exclude pneumonia There is no specific treatment The disease is self limited. Avoid cough syrups and antihistamines. Slide 16 THANK YOU