A 2-year-old girl is brought to the ED by her parents. They state that she has been suffering from a cold for five days. They became concerned when she developed a barking cough and noisy breathing. Examination reveals a listless child with a mild fever, inspiratory stridor, and diminished breath sounds.
Which one of the following is the most likely pathogen?
Correct Answer C:
Croup is acute inflammation of the upper and lower respiratory tracts caused most commonly by parainfluenza virus type 1 infection. It is characterized by a barking cough and inspiratory stridor. Diagnosis is usually obvious clinically but can be made by anteroposterior neck x-ray. Treatment is antipyretics, hydration, nebulized racemic epinephrine, and corticosteroids. Prognosis is excellent.
Which of the following steps is not indicated in the management of croup?
Correct Answer D:
Croup is acute inflammation of the upper and lower respiratory tracts caused most commonly by parainfluenza virus type 1 infection. It is characterized by a barking cough and inspiratory stridor. Diagnosis is usually obvious clinically but can be made by anteroposterior neck x-ray.
Treatment:
Which one of the following has been shown to reduce the croup score in children and lead to shorter hospital stays?
Correct Answer A:
Croup is a viral illness and is not treated with antibiotics. Racemic epinephrine may be used acutely, but rebound can occur. Albuterol has not been shown to be helpful. Oral or intramuscular dexamethasone, 0.6 mg/kg as a single dose, and nebulized budesonide have been shown to reduce croup scores and shorten hospital stays.
A previously healthy 20-month-old female is brought to the urgent-care clinic during the evening with a barking cough. On examination her rectal temperature is 37.9°C (100.2°F), respiratory rate 18/min, heart rate 120 beats/min, and O2 saturation 94%. She has stridor, with mild substernal retractions only when her temperature was taken.
Which one of the following would be most appropriate at this point?
Croup can be classified as spasmodic croup, laryngotracheitis, laryngotracheobronchitis (LTB), laryngotracheobroncheopneumonia (LTBP), or laryngeal diphtheria. Mild croup is manifested by an occasional barking cough with no stridor at rest, and mild or absent intercostal retractions. Moderate croup presents with a more frequent barking cough, stridor with suprasternal and sternal retractions at rest, but no agitation. Severe croup includes more prominent inspiratory and expiratory stridor with agitation and distress.
There is good evidence that corticosteroids produce significant improvement. The regimens studied most frequently have consisted of single-dose dexamethasone (0.6 mg/kg orally or intramuscularly), with some studies including up to four more doses over a 2-day period. Longer courses of corticosteroids have not proven to be more effective and may be harmful, leading to secondary infections. Racemic epinephrine by nebulization is indicated in severe croup. Antitussives and decongestants have not been studied and are not recommended. Antibiotics are indicated in LTB and LTBP, which can be diagnosed on the basis of crackles and wheezing on examination, or by an abnormal chest radiograph. Laryngotracheitis can sometimes be associated with a bacterial infection, but should be suspected only after a patient does not improve with corticosteroids and epinephrine.
Which one of the following is true concerning the use of dexamethasone to treat acute laryngotracheitis (croup)?
Treatment with corticosteroids is now routinely recommended for acute laryngotracheitis (croup). A single dose of dexamethasone, either orally or intramuscularly, is appropriate. Prolonged courses of corticosteroids provide no additional benefit and may lead to secondary bacterial or fungal infections. Secondary infections rarely occur with single-dose treatment. Corticosteroid therapy shortens emergency department stays and decreases the need for return visits and hospitalizations. It is indicated for patients with croup of any severity.
Click to expand