1. Laryngotracheobronchitis Croup (LTB) Infections Islamic University Nursing College

2. Stridor
It is the noise caused by obstruction of airflow due to narrowing in respiratory tract
It may be inspiratory /expiratory
Inspiratory stridor alone indicates that the lesion is at vocal cord level or above
An expiratory phase occurs when the tracheal lumen is also narrowed by oedema or inflammation

3. Acute Laryngeal infections in childhood
Acute Epiglottitis
Laryngotrachealbronchitis
Bacterial Laryngotrachealbronchitis
Diphtheria
Conditions which like laryngeal infections

4. Laryngotracheobronchitis (Croup)
As name suggests it involves larger proportion of respiratory tract (larynx, trachea, bronchi)
Area of maximum impact is sub-glottis
An acute illness with hoarseness, a barking cough, stridor and varying degree of respiratory distress
Affects young children (6 months to 3 years)

5. In most cases causative organism is paramyxovirus, para-infleunza virus type I and type II
In adults it may also occur from herpes simplex, cytomegalovirus & influenza virus
Adult croup is rare, more severe & impaired immunity should always be considered
The key feature is sub-glottic oedema

6. Symptoms: Mostly occur suddenly at night. Obstruction of airway
Mucus production.
Audible in-spiratory stridor.
Hoarseness of voice due to laryngeal edema
Fever.

7. Investigations
Direct viral antigen detection by sampling mucus from nasopharynx
A plain neck radiograph may show narrowing of the subglottis (steeple sign) and ballooning of hypopharynx
Chest X-ray to exclude collapsed lobes or meditational shift

8. Management
Oxygen, steroids and nebulized epinephrine should be administered
Monitor airway and oxygen saturation, consider endotracheal intubation if necessary
Broad spectrum antibiotics to cover secondary infection
No evidence to support antiviral agents

9. Management in simple cases
Single dose of steroids.
Epinephrine is used in more severe cases.
Hospitalization rarely used.
Complications: Resipratoy distress, hypoxia

10. Thank you