Croup Diagnosis and Management

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Questions and Answers

What is the primary indication for radiographic imaging in croup?

  • To diagnose subglottic stenosis
  • To rule out epiglottitis or bacterial tracheitis
  • To identify the steeple sign
  • None of the above (correct)

What is the significance of the steeple sign in croup?

  • It is a specific sign for croup
  • It is only seen in laryngomalacia
  • It is a sensitive sign for croup
  • It is neither specific nor sensitive for croup (correct)

When is laryngoscopy indicated in croup?

  • When stridor is present at rest
  • In all cases of croup
  • Only in atypical presentations or suspected alternate diagnoses (correct)
  • When the Westley Croup Score is high

What is the concern when performing laryngoscopy in suspected epiglottitis?

<p>Rapid airway obstruction (A)</p> Signup and view all the answers

What is the primary factor in determining the management of croup?

<p>The severity of illness (C)</p> Signup and view all the answers

What is a possible indication for computed tomography of the neck in croup?

<p>To identify an abscess, tumor, or foreign body aspiration (B)</p> Signup and view all the answers

What is laryngomalacia?

<p>A large airway lesion (D)</p> Signup and view all the answers

What is the score used to assess the severity of croup?

<p>Westley Croup Score (D)</p> Signup and view all the answers

What is the primary purpose of placing a symptomatic child in a comfortable position?

<p>To improve the evaluation and treatment process (D)</p> Signup and view all the answers

According to the Westley Croup Score, what is the category of croup severity corresponding to a total score of 3 to 7?

<p>Moderate (D)</p> Signup and view all the answers

What is the recommended treatment for children with hypoxemia or severe respiratory distress?

<p>Oxygen administration (B)</p> Signup and view all the answers

What is the importance of minimizing agitation in a symptomatic child?

<p>To help improve symptoms (C)</p> Signup and view all the answers

What is the name of the algorithm provided in Figure 1 for managing children with croup in an outpatient setting?

<p>Not specified in the content (A)</p> Signup and view all the answers

What is the severity of croup corresponding to a total score of ≤2 on the Westley Croup Score?

<p>Mild (B)</p> Signup and view all the answers

What is the reference for the study mentioned in the content regarding nebulized racemic epinephrine by IPPB for the treatment of croup?

<p>Am J Dis Child. 1978;132(5):485 (C)</p> Signup and view all the answers

What is the purpose of humidified air inhalation in croup management?

<p>Historically used for management of croup (B)</p> Signup and view all the answers

What are the typical clinical findings of croup?

<p>Barking cough, stridor, and hoarseness (B)</p> Signup and view all the answers

Is diagnostic testing necessary for croup?

<p>No, clinical findings are sufficient for diagnosis (D)</p> Signup and view all the answers

What is the effect of humidified air inhalation on croup symptoms?

<p>It has no effect on symptoms (D)</p> Signup and view all the answers

Who should receive corticosteroids for croup?

<p>Patients with croup of any severity (D)</p> Signup and view all the answers

When should epinephrine be administered to patients with croup?

<p>In patients with moderate to severe croup (D)</p> Signup and view all the answers

What is the typical age range for patients who receive corticosteroids for croup?

<p>Six months to 5 years (B)</p> Signup and view all the answers

What is the effect of corticosteroids on croup symptoms?

<p>They significantly improve symptoms (C)</p> Signup and view all the answers

What is the typical respiratory rate in patients with croup?

<p>Increased (B)</p> Signup and view all the answers

What is the primary mechanism of action of epinephrine in improving symptoms in patients with croup?

<p>Arteriole vasoconstriction in the upper airway mucosa (C)</p> Signup and view all the answers

What is the recommended dose of dexamethasone for the treatment of croup?

<p>0.15 to 0.60 mg per kg orally or parenterally, single dose (D)</p> Signup and view all the answers

What is the primary difference between mild and moderate or severe croup?

<p>Frequency of barking cough (C)</p> Signup and view all the answers

What is the purpose of the Westley Croup Score?

<p>To assess the severity of croup (C)</p> Signup and view all the answers

What is the effect of corticosteroids on the resolution of symptoms in children with acute respiratory conditions?

<p>Faster resolution (A)</p> Signup and view all the answers

What is the recommended treatment for mild croup?

<p>Single dose of dexamethasone (B)</p> Signup and view all the answers

What is the primary benefit of using dexamethasone in the treatment of croup?

<p>Rapid onset of action (D)</p> Signup and view all the answers

What is the primary indication for using epinephrine in the treatment of croup?

<p>Moderate or severe croup (A)</p> Signup and view all the answers

What is the typical duration of epinephrine's effects in patients with croup?

<p>One to two hours (C)</p> Signup and view all the answers

Why is dexamethasone the preferred corticosteroid for croup treatment?

<p>It is given as a single dose and can be administered orally, intramuscularly, or intravenously. (A)</p> Signup and view all the answers

What is the recommended dose of dexamethasone for croup treatment?

<p>0.6 mg per kg (A)</p> Signup and view all the answers

What is the advantage of using dexamethasone over budesonide in croup treatment?

<p>Dexamethasone is superior to budesonide in improving symptoms scores. (B)</p> Signup and view all the answers

Why should patients receiving frequent nebulized epinephrine treatments be monitored?

<p>For adverse cardiac effects (C)</p> Signup and view all the answers

What is the purpose of monitoring patients for at least two hours after epinephrine administration?

<p>To ensure the effects of epinephrine have worn off (D)</p> Signup and view all the answers

What is the significance of using dexamethasone in the emergency department or hospital?

<p>It reduces the risk of return visits or readmissions (B)</p> Signup and view all the answers

What was the purpose of the PubMed search conducted for this article?

<p>To update previous articles on croup (A)</p> Signup and view all the answers

Flashcards

Radiographic Imaging in Croup?

Typically not needed; rely on clinical findings.

Steeple Sign Significance?

Neither specific nor sensitive for croup.

Laryngoscopy Indication?

Only in atypical cases or suspected alternate diagnoses.

Croup Management Factor?

The severity of the illness

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CT Scan Indication?

Abscess, tumor, or foreign body.

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Westley Croup Score?

Assess croup severity.

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Comfortable Position?

Improve evaluation and treatment.

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Westley Score 3-7?

Moderate Croup

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Hypoxemia or Distress?

Oxygen administration.

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Minimize Agitation?

To help improve symptoms

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Croup Clinical Findings?

Barking cough, stridor, and hoarseness.

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Diagnostic Testing Needed?

No, clinical findings are sufficient.

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Humidified Air Effect?

It has no effect on symptoms.

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Who Gets Corticosteroids?

Patients with croup of any severity.

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When Use Epinephrine?

Moderate to severe croup.

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Corticosteroid Typical Age?

Six months to 5 years.

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Corticosteroid Effect?

They significantly improve symptoms.

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Epinephrine Mechanism?

Arteriole vasoconstriction in the upper airway mucosa.

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Dexamethasone Dose?

0.15 to 0.60 mg/kg orally or parenterally, single dose.

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Mild vs. Moderate/Severe?

Frequency of barking cough.

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Westley Croup Score Purpose?

To assess the severity of croup.

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Corticosteroids Resolution Effect?

Faster resolution.

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Mild Croup Treatment?

Single dose of dexamethasone.

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Dexamethasone Benefit?

Rapid onset of action.

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Epinephrine Indication?

Moderate or severe croup.

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Epinephrine Duration?

One to two hours.

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Dexamethasone Advantage?

Given as a single dose and can be administered easily; superior symptom score.

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Dexamethasone Dose

0.6 mg per kg

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Advantage Over Budesonide

Dexamethasone is superior to budesonide in improving symptoms scores.

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Monitor Frequent Epi?

For adverse cardiac effects.

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Study Notes

Croup Diagnosis and Management

  • Diagnosis of croup is based on clinical findings of barking cough, inspiratory stridor, and hoarseness.
  • Diagnostic testing is typically not necessary, and the absence of fever does not rule out croup.
  • Respiratory rate is often increased in patients with croup.

Croup Treatment

  • Corticosteroids should be administered to patients with croup of any severity.
  • Epinephrine should be administered to patients with moderate to severe croup.
  • Humidified air inhalation does not improve symptoms in patients with moderate croup.
  • Oxygen should be administered to children with hypoxemia or severe respiratory distress.

Westley Croup Score

  • The Westley Croup Score is used to assess the severity of croup.
  • The score is based on clinical signs such as level of consciousness, stridor, air entry, and retractions.
  • A score of ≤2 indicates mild croup, 3-7 indicates moderate croup, and ≥12 indicates impending respiratory failure.

Outpatient Management

  • Minimizing agitation in a symptomatic child can help improve symptoms.
  • Placing the child in a comfortable position may help improve the evaluation and treatment process.
  • Dexamethasone is the preferred corticosteroid due to its single-dose administration and ability to be given orally, intramuscularly, or intravenously.
  • The optimal dose of dexamethasone is unclear, but 0.6 mg per kg is the most commonly used.

Use of Epinephrine

  • Epinephrine is thought to improve symptoms in patients with croup through arteriole vasoconstriction in the upper airway mucosa.
  • The effects of epinephrine wane after one to two hours, so patients should be monitored for at least two hours after administration.
  • Adverse effects of nebulized epinephrine are rare, but patients receiving frequent treatments should be monitored for adverse cardiac effects.

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