Epiglottitis and Croup
By
Stacey Singer-Leshinsky R-PAC
Laryngotracheal bronchitis
Viral Croup
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Known as laryngotracheitis or
laryngotracheobronchitis
Most common etiology is viralParainfluenza virus, adenovirus, RSV
Laryngotracheal bronchitis
Viral Croup
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Leads to infection and inflammation of
the larynx and subglottic area
Decreased mobility of the vocal cords
Frequently affects children
Viral Croup
Clinical Manifestations
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Begins with respiratory symptoms
Within 2 days progresses to:
Hoarseness
Barking seal like cough
StridorSymptoms worse at night
Fever
Viral Croup
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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.
Laryngotracheal bronchitis
Croup-Diagnosis
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A/P neck x-ray:
subglottic narrowing
CBC might show
lymphocytosis-
Croup
Differentials
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Diphtheria
Epiglottitis
Peritonsillar abscess
Inhalation injuries
Viral CroupManagement
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Cool air mist, steam from bathroom,
exposure to outdoor cool air
Adequate hydration
Glucocorticoids
Racemic epinephrine
Dexamethasone for severe cases
Viral CroupManagement
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Hospitalization indications
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DehydrationSignificant respiratory compromise
Signs of respiratory failure
Complications:
Prognosis:
Spasmodic Croup
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No prodrome of upper respiratory
syndrome.
Subglottic edema
Affects individual at night.
Affects children between 1-3 years
Managed at home
Epiglotittis
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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
Epiglotittis
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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 betahemolytic streptococci .
EpiglotittisClinical Manifestations
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Triad of drooling, dysphagia, and
distress.
High fever
Positioning- tripod position
Dyspnea/ Inspiratory stridor/ accessory
muscle use / muffled voice
Brassy cough
Epiglottitis
Diagnosis
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Lateral neck -enlarged
edematous epiglottis.
Laryngoscopy: Direct
inspection of epiglottis
under controlled
conditions
Leukocytosis
Blood cultures positive
Epiglotittis
Differentials
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Anaphylaxis
Croup
Retropharyngeal Abscess
Foreign body obstruction
Epiglotittis
Management
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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
Epiglotittis
Management
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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
Review 1
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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?
Review 2
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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 xray?
What is the etiology of this?