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Epiglottitis and Croup

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					Epiglottitis and Croup

                By
  Stacey Singer-Leshinsky R-PAC
Laryngotracheal bronchitis
Viral Croup
   Known as laryngotracheitis or
    laryngotracheobronchitis
   Most common etiology is viral-
    Parainfluenza virus, adenovirus, RSV
Laryngotracheal bronchitis
Viral Croup
   Leads to infection and inflammation of
    the larynx and subglottic area
   Decreased mobility of the vocal cords
   Frequently affects children
Viral Croup
Clinical Manifestations
   Begins with respiratory symptoms
   Within 2 days progresses to:
   Hoarseness
   Barking seal like cough
   Stridor-
   Symptoms worse at night
   Fever
     Viral Croup

   Mild disease: occasional barking
    cough, no stridor at rest, mild to
    no suprasternal retractions
   Moderate: frequent cough,
    audible stridor at rest, retractions,
   Severe: frequent cough,
    inspiratory/expiratory stridor,
    retractions, decreased air entry,
    distress, and agitation.
Laryngotracheal bronchitis
Croup-Diagnosis
   A/P neck x-ray:
    subglottic narrowing
   CBC might show
    lymphocytosis-
Croup
Differentials
   Diphtheria
   Epiglottitis
   Peritonsillar abscess
   Inhalation injuries
Viral Croup-
Management
   Cool air mist, steam from bathroom,
    exposure to outdoor cool air
   Adequate hydration
   Glucocorticoids
   Racemic epinephrine
   Dexamethasone for severe cases
Viral Croup-
Management
   Hospitalization indications
       Dehydration-
       Significant respiratory compromise
       Signs of respiratory failure

   Complications:
   Prognosis:
Spasmodic Croup
   No prodrome of upper respiratory
    syndrome.
   Subglottic edema
   Affects individual at night.
   Affects children between 1-3 years
   Managed at home
Epiglotittis
   The epiglottis is a
    cartilaginous structure
    covered with mucous
    membrane
   Epiglottitis is an acute
    inflammation of the epiglottis
    and pharyngeal structures
   Can be severe life
    threatening disease
Epiglotittis
   Primarily affects children 2-7 years.
    Presents more acutely in young children
   Etiology: H. influenzae type B, also
    group A S pneumoniae, H
    parainfluenzae, S aureus, and beta-
    hemolytic streptococci .
Epiglotittis-
Clinical Manifestations
   Triad of drooling, dysphagia, and
    distress.
   High fever
   Positioning- tripod position
   Dyspnea/ Inspiratory stridor/ accessory
    muscle use / muffled voice
   Brassy cough
Epiglottitis
Diagnosis
   Lateral neck -enlarged
    edematous epiglottis.
   Laryngoscopy: Direct
    inspection of epiglottis
    under controlled
    conditions
   Leukocytosis
   Blood cultures positive
Epiglotittis
Differentials
   Anaphylaxis
   Croup
   Retropharyngeal Abscess
   Foreign body obstruction
Epiglotittis
Management
   Secure airway with endotracheal intubation.
    Might need cricothyroidotomy.
   Child should sit upright
   Humidified oxygen
   Hospitalization
   No tongue blades
   IV antibiotics:Ceftriaxone (Rocephin)
    cefotaxime (Ceftin), Ampicillin with
    chloramphenicol

Epiglotittis
Management
   Evaluate for extubation 24-48 hours
    post intubation.
   24-48 hours post extubation
   Rifampin prophylaxis for 4days for
    household contacts if: children in
    household have not been vaccinated
    with the entire series
Review 1
   A 4 year old is brought to the Emergency
    Room with her mother at 4am. Mother states
    child is coughing funny. Child has a two day
    history of an upper respiratory infection.
   What is the differential diagnosis?
   How would this child be treated?
   When would this child be hospitalized?
   What findings are expected on neck x-ray?
Review 2
   A 6 year old female is brought to the ED by
    her father. Father states female is very sick.
    She is drooling and has a high fever.
   What is the differential diagnosis?
   What are some other clinical manifestations
    that might be expected?
   How would this child be treated?
   Should this child be hospitalized?
   What findings are expected on lateral neck x-
    ray?
   What is the etiology of this?