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 4^th 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

Disposition:

Patients without stridor at rest or respiratory distress can be generally discharged from the ED
If epinephrine is given, patients should be monitored for 2-4 hours for reemergence of symptoms as the medication wears off

Take Home Points

Croup usually affects children within the age range of 6 months to 36 months with the most common cause being parainfluenza virus
Given the symptom overlap, we must consider more concerning diagnoses, including bacterial tracheitis, in these patients, especially if they are ill appearing or traditional therapies are ineffective
All patients benefit from a one-time dose of dexamethasone and, if racemic epinephrine is given, the patient should be observed for at least 3 hours
If intubation is required, anticipate a narrowed airway

Parent Article: https://coreem.net/core/croup/ by Dr. Pankow

Episode 163.0 – Croup