Epiglottitis and Croup By Stacey Singer-Leshinsky R-PAC

Laryngotracheal bronchitis Viral Croup Known as laryngotracheitis or laryngotracheobronchitis Most common etiology is viral- Parainfluenza virus, adenovirus, RSV

Laryngotracheal bronchitis Viral Croup Leads to infection and inflammation of the larynx and subglottic area Decreased mobility of the vocal cords Frequently affects children

Viral Croup Clinical Manifestations Begins with respiratory symptoms Within 2 days progresses to: Hoarseness Barking seal like cough Stridor- Symptoms worse at night Fever

Viral Croup 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 A/P neck x-ray: subglottic narrowing CBC might show lymphocytosis-

Croup Differentials Diphtheria Epiglottitis Peritonsillar abscess Inhalation injuries

Viral Croup- Management Cool air mist, steam from bathroom, exposure to outdoor cool air Adequate hydration Glucocorticoids Racemic epinephrine Dexamethasone for severe cases

Viral Croup- Management Hospitalization indications  Dehydration-  Significant respiratory compromise  Signs of respiratory failure Complications: Prognosis:

Spasmodic Croup No prodrome of upper respiratory syndrome. Subglottic edema Affects individual at night. Affects children between 1-3 years Managed at home

Epiglotittis 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 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 beta- hemolytic streptococci.

Epiglotittis- Clinical Manifestations Triad of drooling, dysphagia, and distress. High fever Positioning- tripod position Dyspnea/ Inspiratory stridor/ accessory muscle use / muffled voice Brassy cough

Epiglottitis Diagnosis Lateral neck -enlarged edematous epiglottis. Laryngoscopy: Direct inspection of epiglottis under controlled conditions Leukocytosis Blood cultures positive

Epiglotittis Differentials Anaphylaxis Croup Retropharyngeal Abscess Foreign body obstruction

Epiglotittis Management 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 Evaluate for extubation hours post intubation hours post extubation Rifampin prophylaxis for 4days for household contacts if: children in household have not been vaccinated with the entire series

Review 1 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 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 x- ray? What is the etiology of this?