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Croup%20 %20Stridor%20in%20Children

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Croup + Stridor in Children Caitriona Broderick Source: PALS Guidelines Stridor An abnormal, high-pitched sound produced by turbulent airflow through a partially ... – PowerPoint PPT presentation

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Title: Croup%20 %20Stridor%20in%20Children


1
Croup Stridor in Children
  • Caitriona Broderick
  • Source PALS Guidelines

2
Stridor
  • An abnormal, high-pitched sound produced by
    turbulent airflow through a partially obstructed
    airway at the level of the supraglottis, glottis,
    subglottis, or trachea.
  • Inspiratory stridor laryngeal obstruction
  • Expiratory stridor tracheobronchial obstruction
  • Biphasic stridor subglottic or glottic anomaly
  • Symptom not a diagnosis or disease
  • Causes
  • Croup- viral laryngotracheitis
  • Croup- recurrent or spasmodic
  • Laryngeal foreign body
  • Epiglottitis
  • Croup- bacterial tracheitis
  • Trauma
  • Retropharyngeal abscess

3
Definition
  • Croup acute clinical syndrome with
  • Inspiratory stridor
  • Barking cough
  • Hoarseness
  • Variable degrees of respiratory distress
  • Preceded by fever, coryza for 1-3 days
  • Symptoms often start and are worse at night
  • Can deteriorate rapidly
  • Commonest Cause (95)
  • Acute viral laryngotracheobronchitis (viral
    croup)
  • Pathogens Parainfluenza virus, RSV, adenoviruses
  • Peak incidence 2nd year of life
  • Most hospital admissions 6mths-5years

4
Initial Management? ABC
5
  • Responsiveness?
  • Airway
  • Vocalisations
  • Patency chest movement /- abdominal movement,
    symmetry, recession
  • Listen for breathing sounds and stridor
  • Feel for expired air
  • Reassess after any airway manoeuvres
  • Suction secretions
  • Chin lift or jaw thrust manoeuvre
  • Oro or nasopharyngeal airway device
  • Intubation with senior help

6
  • Breathing
  • Effort of breathing
  • Respiratory Rate
  • Stridor
  • Accessory muscle use
  • Recession
  • Wheeze
  • Flaring of nostrils
  • Grunting
  • Gasping
  • Efficacy of breathing
  • Chest expansion
  • Breath sounds reduced/absent/
  • Symmetry on ausculataion
  • SpO2
  • 10-15L/min 100 O2
  • SpO2 94-98

7
  • Circulation
  • Heart Rate
  • Pulse Volume
  • Capillary Refill
  • Skin Temperature
  • Disability
  • Mental status/ conscious level
  • Posture
  • Pupils
  • Exposure
  • Rash or fever
  • Fluid Bolus 20ml/kg of 0.9 saline

8
Severe Respiratory Distress Harsh Stridor
Barking Cough
  • Nebulised Adrenaline
  • 400mcg/kg 0.4ml/kg of 11000
  • With oxygen
  • Via Face mask
  • May need to be repeated

9
Oral Dexamethasone 150mcg/kg Or Inhaled
Nebulised Budesonide 2mg
  • Both equally effective
  • May be repeated after 12 hours if clinically
    indicated
  • lt5 require tracheal intubation
  • Tachycardia, tachypnoea, chest retraction,
    cyanosis, exhaustion or confusion.

10
Croup Summary
  • ABC
  • Nebulised Adrenaline
  • Oral Dexamethasone or Inhaled Budesonide
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