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Croup Stridor in Children

• Caitriona Broderick
• Source PALS Guidelines

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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

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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

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Initial Management?ABC
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• 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

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• 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

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• 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

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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

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Oral Dexamethasone 150mcg/kg OrInhaled
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.

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Croup Summary

• ABC
• Nebulised Adrenaline
• Oral Dexamethasone or Inhaled Budesonide