Croup or Laryngotracheobronchitis

Posted by e-Medical PPT Thursday, July 8, 2010
Croup (laryngotracheobronchitis) is an acute viral infection of the upper airway, leading to swelling and the classical symptoms of a "barking" cough, stridor, and hoarseness which often worsen at night. It is a common infection that occurs in 15% of children, usually between 6 months and 5–6 years of age.It is often treated with a single dose of oral steroids; occasionally epinephrine is used in more severe cases. Hospitalization is rarely required.
Croup is a clinical diagnosis.The first step is to exclude other obstructive conditions of the upper airway, especially epiglottitis, an airway foreign body, subglottic stenosis, angioedema, retropharyngeal abscess, and bacterial tracheitis.A frontal X-ray of the neck may show the steeple sign, which while suggestive of the diagnosis, is not routinely performed. Other investigations (such as blood tests and viral culture) are discouraged as they may cause unnecessary agitation and, thus, worsen compromise of the airway.While viral cultures, obtained via nasopharyngeal aspiration, can be used to confirm the exact cause.Bacterial infection should be considered if a person does not improve with standard treatment, at which point further investigations may be indicated

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