Croup

croup or Lorraine depart trachea bronchi this is the topic for this video so let’s get started croup is brave mostly an inflammatory process it involves the swelling of the respiratory tracts the both upper and lower and it’s most commonly caused by viruses and those viruses are parainfluenza perro influenza is by far the most common in its category 1 but there are several others that could cause group including respiratory syncytial virus and the influenza viruses influenza A and B now this croup is basically an sorenes of the larynx trachea and the bronchioles including all the way down to the lung and let me show you a little diagram that sort of illustrates that so here we are this is the larynx and this is the trachea and this is a healthful airway right here as you can see it’s very paitent but then this is group now notice the protrude tissue here what it’s doing it’s shrinking the airway and that that constricting is what leads to the symptomatology of croup you can clearly see that there so what are the symptoms what are the evidences that can occur well that’s swelling that I just demo you with sorenes in that sub but glottic region can lead to the following evidences and some of these are pretty classic you’ve got this barking cough roughly that sounds like a seal that’s routinely described you have something called Strider Strider what is Strider well Strider mostly is a high-pitched wheezing sound resultant from that tumultuou airflow in that airway that’s been shrunk and I wanted to play for you the Strider so you can get an idea of what it sounds like so let’s see if this so that’s what Strider sounds like now that hubbub is happening because that airway is constricted and or hampered and that high-pitched wheezing chime results when a when a child breathes basically now these indications most often happen at night and another thing that’s important as a child can often show retractions and our attractions are these where the sternal area starts to draw inward the sternal in traces in chooses and I’ll demonstrate you a picture of a child with those turtle in portrays that’s right here if you can see the middle area there do you see how that various kinds of caves in and that’s what we want by those retractions okay so now let’s go talk a little bit about the evidences and not the symptoms the diagnosis evidences we just talked about all right so diagnosis how do you diagnose this the child comes in and and he’s he or she has got these manifestations and I’ll just before I get into the diagnosis of fever can occur about 50% of the time so I just wanted to quickly mention that okay so how do we diagnose croup well other than the indications that are pretty classic like the barking cough and the inspiratory stridor that I frisked a recording for you yeah you do x-rays of the neck and when you do the x-rays of the neck you can actually see that airway narrowing you remember that airway shrinking that are available well you can actually be understood that and that actually has a special name given to it it’s called steeple ratify and will expect because of steeples it was like that and let me show you a chest x-ray no sorry not a chest x-ray a neck x-ray and this is the steeple sign if you can kind of see it’s got that triangular mold that’s instantly the result of this type of narrowing of the airway so that’s pretty classic other things that you can do in part of the diagnostic workup of croup are made a pulse ox on the child to monitor their oxygen saturation arterial blood gases are important because what happens after a while is the child can get tired and the child can eventually if serious enough develop hypercapnia and hypercapnia virtually is when the co2 levels rise and that needs to be measured measured so co2 levels can need to be measured if the child’s condition degenerates and we’ll throw in the towel a temperature in there you know doesn’t hurt all right so it’s a rather simple a symptom and symptomatology and diagnostic workup so then how do you treat it well you’ve diagnosed it how do you treat it well I’m going to break up the treatment into three fractions the first part is really referring to really the outpatient type of treatment slight slight instance of croup the next character is inpatient and then the third is the severe I talked a little about each well the basics of outpatient is really exactly you know bringing down the delirium with an antipyretic you are familiar with children most commonly I’ll establish an ibuprofen or acetaminophen and keep the child hydrated hydration but outpatient can also involved something that is used known as humidified breeze now what’s this all about what some yuta fighter well vibrate unified breeze is can amend the upper airway drying and that’s the main reason these these vaporizers or humidifiers are used to prevent the upper Airways from drying out and then oral cortical steroids oral corticosteroids now remember the basic fundamental definition of croup or low-spirited direction trachea bronchi toises that’s an inflaming so the steroids weaken that sorenes plain and simple now let’s get into the inpatient treatment Charles been hospitalized and you want to treat the child how would you do that well interestingly two of these are the same you also utter humidified oxygen in the in research hospitals and you too sacrifice steroids for the same reasons that I talked about earlier but another thing that’s given in the hospital is something called racemic epinephrine epinephrine what this acts as is a bronchodilator and this bronchodilator is to be found in a nebulized anatomy and can them definitely offer symptomatic comfort and also alleviate the wearines that children can develop when they have to you know work so hard to breathe during an infection now in the severe severe cases most severe cases where the child is has increasing respiratory distress fatigue you know that I has spoken about “youve been” must be ensured that you check the co2 heights and at the co2 level the arterial co2 level is greater than 45 then that makes the child isn’t indeed getting very tired and exactly having very difficult time they’re expelling the co2 so they need intubation endotracheal intubation – intubation and that will give the child a interrupt mostly and allow the child to get their ABG’s at arterial blood gases down to regular and one final thing I’d like to mention is antibiotics do you use them or do you not use them yes or no well viruses are the most common cause of croup so you don’t really need to use an antibiotic so the answer is no antibiotics are rarely used in croup I really want to finish off the presentation or video with a small vignette here “theres going” three year old boy brought to the emergency room by his mothers in the late evening he has developed a rapid onslaught of seal-like barking cough will be followed by clear nasal fulfill his parents became alarmed when he developed Strider which perseveres throughout the trip to the hospital on exam he has a seal like vivaciou cough an inspiratory stridor when at rest which deteriorates with fermentation persistent sternal in paint are also evident at risk what helps to have a picture of those in paints right next to you well this is obviously a clinical vignette describing croup