Croup vs. Epiglottitis

CROUP

(LTB or Laryngotracheobronchitis)

·         Age: 3 mons – 3 years

·         Subglottic swelling

·         CXR:  Either AP or lateral neck, hourglass or steeple sign

·         CBC usually normal

·         Low-grade fever

·         Barking cough, insp. Upper airway stridor, hoarse, could have retraction if severe

·         Virus, inflammation of the subglottic are causing partial laryngeal obstruction

·         Parainfluenza is common virus

·         Onset is gradual

·         History of cold symptoms

·         No antibiotics

·         Should be admitted if there is inspiratory & exp. Stridor at rest & retractions. PICU is best idea

·         Treat w/ racemic epinephrine to reduce swelling (.25ml of 2.25% & 2ml normal salin)

·         Cool mist (w/ O2 if necessary)

·         Steroid such as Decadron (& possibly Budesonide)

·         If it is untypically severe may need heliox or intubation, but this is extremely rare.

EPIGLOTTITIS

·         Inflammatory of epiglottis & surrounding

·         Age: 2 -6 years old

·         Supraglottic swelling

·         CXR: Lateral neck à thumb sign

·         Leukocytosis

·         High fever

·         Anxious, triod position, drooling, stridor, no cough, retraction

·         Bacterial invasion of soft tissue of larynx including the epiglottis

·         Typically caused by Haemophilus influenza type B

·         Very rapid onset

·         IT is Emergency à result in intubated

·         Treat w/ antibiotics

·         Incidence reduce since kids can get Hib vaccination now

·         Don’t attempt direct visualization of the airway, very dangerous

·         Don’t try to draw blood or anything can wait until an airway secured

·         Intubation  should be occur by an expert (such as anesthesiologist) in OR

·         After  intubation, may need ventilation if heavily sedated, but otherwise flowby may be enough, will need restraints

·         After all above now can do other things like blood gas cultures & epiglottis culture to identify the organism

·         Periodically check for decrease swelling through direct visualization now

·         Can extubate after 24-48 hrs

·         Direct visualization show no swelling

·         Leak around ETT w/20 cmH2O of pressure

·         Fever subsided

·         Improve general appearance