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Epiglottitis and Croup

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.

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Epiglottitis and Croup

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  1. Epiglottitis and Croup By Stacey Singer-Leshinsky R-PAC

  2. Laryngotracheal bronchitisViral Croup • Known as laryngotracheitis or laryngotracheobronchitis • Most common etiology is viral- Parainfluenza virus, adenovirus, RSV

  3. Laryngotracheal bronchitisViral Croup • Leads to infection and inflammation of the larynx and subglottic area • Decreased mobility of the vocal cords • Frequently affects children

  4. Viral Croup Clinical Manifestations • Begins with respiratory symptoms • Within 2 days progresses to: • Hoarseness • Barking seal like cough • Stridor- • Symptoms worse at night • Fever

  5. 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.

  6. Laryngotracheal bronchitisCroup-Diagnosis • A/P neck x-ray: subglottic narrowing • CBC might show lymphocytosis-

  7. Croup Differentials • Diphtheria • Epiglottitis • Peritonsillar abscess • Inhalation injuries

  8. Viral Croup-Management • Cool air mist, steam from bathroom, exposure to outdoor cool air • Adequate hydration • Glucocorticoids • Racemic epinephrine • Dexamethasone for severe cases

  9. Viral Croup-Management • Hospitalization indications • Dehydration- • Significant respiratory compromise • Signs of respiratory failure • Complications: • Prognosis:

  10. Spasmodic Croup • No prodrome of upper respiratory syndrome. • Subglottic edema • Affects individual at night. • Affects children between 1-3 years • Managed at home

  11. 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

  12. 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 .

  13. Epiglotittis-Clinical Manifestations • Triad of drooling, dysphagia, and distress. • High fever • Positioning- tripod position • Dyspnea/ Inspiratory stridor/ accessory muscle use / muffled voice • Brassy cough

  14. EpiglottitisDiagnosis • Lateral neck -enlarged edematous epiglottis. • Laryngoscopy: Direct inspection of epiglottis under controlled conditions • Leukocytosis • Blood cultures positive

  15. EpiglotittisDifferentials • Anaphylaxis • Croup • Retropharyngeal Abscess • Foreign body obstruction

  16. EpiglotittisManagement • 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

  17. EpiglotittisManagement • 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

  18. 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?

  19. 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?

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