Pediatric Coughs: Croup
CROUP
Valeria Wu, MD
Presentation: commonly children 6 months to 3 years old, URI and develops into barking cough/hoarseness worse at night
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Usually viral, though can be bacterial
Diagnosis: Clinical. If you get a chest x-ray, can see subglottic narrowing “steeples sign”
Treatment: dexamethasone: 0.6 mg/kg PO or prednisolone 1 mg/kg PO
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antipyretics
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stridor at rest > nebulized epinephrine & observe for at least 3 - 4 hours, repeat as needed
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Repeated epinephrine treatments = admission
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Severe: consider intubation (go with smaller tube, airways may be edematous)
Take note: Remember to keep your differential broad!
Consider-
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Epiglottitis (rare) - respiratory distress, tripoding, less likely to have cough, will have stridor and respiratory distress
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Bacterial tracheitis - stridor as well, productive cough, kid will look sicker, tender trachea/throat
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Foreign body - sudden onset, always have a suspicion for this
References:
Freire G, Shefrin A, Zemek R. Wheezing in Infants and Children. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed October 29, 2020.