Croup

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍hourday history of ‍respiratory distressstridorbarking cough

Onset was ‍gradualsudden, started ‍whileafter ‍ ‍sleeping

Severity is ‍mildmoderatesevere

Worsening factors: ‍nonecryingactivity

Alleviating factors: ‍nonecold air, ‍effectiveineffective



Symptoms include:

‍stridor

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍shortness of breath

‍wheezing

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍hoarsness

‍rhinorrhea, ‍clearcolored

‍nasal congestion

‍sore throat

‍chest tightness

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍fatigue

‍decreased fuild intake

‍decreased appetite



Contributing factors:

‍similar symptoms in close contacts

‍aged 6 months to 3 years

no history of: ‍laryngomalacia, ‍asthma, ‍pneumonia, ‍allergic rhinitis, ‍GERD





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normal, ‍palate intact, ‍redness

Mouth: mucosa ‍normal, dentition ‍normal

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Skin: ‍rashlesions on ‍

Mental status: ‍alert, ‍, reactive to ‍





ASSESSMENT:

‍Viral croup ‍likelysuspectedpossible

DDx: viral croup, spasmodic croup, viral URI, laryngotracheobronchitis, bacterial tracheitis, bronchiolitis, asthma exacerbation, epiglottitis, foreign body aspiration, angioedema, pneumonia, influenza, COVID-19, retropharyngeal abscess, peritonsillar abscess, subglottic stenosis, laryngeal papillomatosis, laryngeal diphtheria





PLAN:

Investigations:

- Chest X-ray

- Blood gas

Treatments:

- Put child on parent's lap in upright position

- Humidified oxygen

- ‍Dexamethasone

- ‍Nebulized epinephrine if resting stridor or significant retractions

- Observe for 3 hours and until resting stridor and retractions resolve

- Hospitalization if no improvement after 3 rounds of epinephrine

- Cold and humidified air (e.g. bathroom with cold shower running)

- Saline nasal irrigation

- Encourage oral hydration

Further care:

- Referral to ER if severe shortness of breath, signs of dehydration, or high fever

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or persist after 3 days