Wile E. Coyote
R. Annie Gough in Injury Illustrated, 2020
Cameron was an athletic and active 10-year-old blonde boy. He had a big smile, but had developed a stubborn, dry cough. For days and days his father hoped to soothe Cameron's cough with all the usual over-the-counter medications. Cameron became weak, not breathing well, truly struggling to get air. His father thought he could be wheezing or experiencing an asthma attack, but Cameron was not asthmatic. It was best to head to their pediatrician, and they did. Cameron's dry cough resembled croup. Croup refers to an infection of the upper airway, which obstructs breathing and causes a characteristic cough. The cough and other symptoms of croup are the result of swelling around the larynx, trachea, and bronchial tubes. When a cough forces air through this narrowed passage, the swollen vocal cords produce a noise similar to a bark, and taking a breath often produces a whistling, suffocating sound called stridor. Croup often begins as a typical cold, it is often worse at night, and is further aggravated by crying and coughing, as well as anxiety and agitation, setting up a cycle of worsening symptoms.
Acute airway conditions
S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague in ENT Head & Neck Emergencies, 2018
Management of croup will depend on the severity of the condition. Mild croup (cough without stridor or sternal recession at rest) can be managed with oral or nebulised corticosteroids. In moderate croup (cough with stridor and sternal recession at rest), give humidified oxygen to keep the oxygen saturations above 93%; nebulised adrenaline should be added to corticosteroids. Resolution of stridor and sternal or intercostal recession should occur within 10 to 30 minutes. The child should be reassessed hourly and, if responding to this treatment regimen, they can be safely discharged home after 4 hours of observation. Severe croup (cough with stridor and sternal recession at rest associated with agitation or lethargy) should be treated with 100% oxygen, nebulised, or parenteral corticosteroids and nebulised adrenaline, and senior anaesthetic help should be sought early.
Clinical specialties
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
A 4-year-old girl attends the emergency department following a 3-day history of coughing and worsening difficulty in breathing, which both get worse at night. She has been well until now, apart from the odd episode of coryzal symptoms. Based on the history, you suspect croup. How is the cough associated with croup usually described? (1)What other symptoms, except for difficulty in breathing, are usually associated with this condition? (2)Give two other causes of developing stridor in this age group. (2)Name two viruses that are commonly responsible for causing croup. (2)What treatment is typically prescribed? (1)In severe disease, what else may be tried before escalation to intensive care? (1)What are severe signs associated with croup? (2)
Multimedia Evaluation of EMT-Paramedic Assessment and Management of Pediatric Respiratory Distress
Published in Prehospital Emergency Care, 2021
Stephanie Schroter, Danny Thomas, Mark Nimmer, Alexis Visotcky, Raphael Fraser, M. Riccardo Colella, Lorin R. Browne
The importance of selecting the correct treatment for a respiratory condition is best demonstrated by looking at the physiology of each condition and how treatment addresses these physiologic changes. For example, asthma causes lower airway obstruction and is treated by β2-agonists (albuterol) that cause relaxation of the lower airways (4, 19–23). Conversely, croup causes upper airway obstruction due to edema of the upper airway caused by respiratory viral infections. Nebulized epinephrine acts through its α1 effect to cause vasoconstriction, addressing the edema, which leads to upper airway obstruction. Albuterol, being a β2 agonist has no significant effect on the α1 receptors making it ineffective for croup. In fact, albuterol’s β-effect could potentially cause and worsen vasodilation, leading to worsening upper airway edema (4, 19–23). Albuterol may also cause significant adverse effects such as tachycardia and tremors when inappropriately given to children with bronchiolitis. As with all inappropriate medication administration, misuse of these treatments for pediatric respiratory distress is associated with increased health care costs (24).
Lymphatic malformation in larynx masquerading as respiratory papillomatosis
Published in Acta Oto-Laryngologica Case Reports, 2021
Bijaya Kharel, Yogesh Neupane
He was admitted two weeks back in a local hospital in the intensive care unit with the diagnosis of Croup and was under mechanical ventilation for three days. He had no history of Asthma, Pulmonary tuberculosis, or any other chronic illness in the past. Flexible Nasopharyngolarygnoscopy in the clinic showed multiple papillomatous growths in the bilateral vallecula, the laryngeal surface of the epiglottis, bilateral aryepiglottic fold, and inter arytenoid area. We could not access the endolarynx properly in the flexible nasopharyngolarygoscopy in an outpatient clinic (Figures 1 and 2). We planned for emergency debulking under general anesthesia with a provisional diagnosis of Juvenile respiratory papillomatosis. Direct laryngoscopy under general anesthesia showed multiple cystic mass presents over bilateral vallecula, lingual and laryngeal surfaces of epiglottis (more on the left side), bilateral arytenoids and aryepiglottic folds, bilateral false vocal cords, lateral pharyngeal walls (more on the left side). But bilateral true vocal cords, subglottic area, and trachea were free of disease.
Prognostic factors and importance of recognition of adult croup
Published in Acta Oto-Laryngologica, 2018
Tomoyasu Tachibana, Yorihisa Orita, Takuma Makino, Yasutoshi Komatsubara, Yuko Matsuyama, Yuto Naoi, Michihiro Nakada, Yasuharu Sato, Kazunori Nishizaki
Croup, or laryngotracheobronchitis, is a common inflammatory disease in childhood characterized by barking cough, hoarseness, and stridor [1–3]. Severe croup patients can require airway intervention such as tracheal intubation or tracheostomy to maintain the airway. The characteristics of adult croup (AC) have not been well described. To delineate prognostic factors for AC, the present study retrospectively investigated the clinical features of AC patients treated in our department.
Related Knowledge Centers
- Cough
- Fever
- Orthomyxoviridae
- Respiratory Tract Infection
- Rhinorrhea
- Stridor
- Trachea
- Virus
- Hoarse Voice
- Parainfluenza Viruses