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Croup-1 - Croup Not all that barks is viral Craig Dobson MD...

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Croup: Not all that barks is viral! Craig Dobson, MD CPT, MC, USAR NCC Pediatrics
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Definitions Croup - term used to describe the clinical picture of laryngotracheitis. Hoarse voice Barking cough Inspiratory stridor Possible respiratory distress
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Epidemiology Peak fall & winter. Range primarily 1-6 years Incidence 5/100 of children between age 1-2 years Males > females
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Etiologies Parainfluenza, types 1,2,3 Contribute 65% of cases. Influenza A & B Adenovirus RSV Rarely mycoplasma.
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Pathogenesis Subglottic narrowing due to inflammation. Cricoid ring allows fixed area for obstruction. 1mm swelling causes 65% obstruction in infant.
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Pathogenesis Atelectasis/mucus plugging Ventilation/perfusion mismatch Negative intrapleural pressure may lead to varying degrees of pulmonary edema. Hypoxia/hypercarbia Air hunger Anxiety/Lethargy/Obtundation.
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Clinical history Parents usually report viral URI symptoms 12-48hrs prior to cough. Fever, “Barking cough,”Stridor Typical course 3-5 days.
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Worry if Drooling Dyphagia Toxic appearance Stridor without cough or without fever Incomplete immunizations
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Badness mimicking croup Epiglottis Dysphagia Odynophagia Drooling Tripoding/sword-swallowing Pt resists lying on back Prefers leaning forward Stat to OR for evaluation/intubation
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Badness Mimicking Croup, cont.
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