1. Croup Syndrome

2. Croup Syndrome
Croup: is general term applied to complex characterized by:
horsiness, resonant cough, barking or brassy (croupy).
Inspiration stridor.
Respiratory distress r/to swelling or obstruction of larynx.
Croup Syndrome can affect larynx, trachea, bronchi__ affect voice & breathing.
Croup syndrome are described according to the primary anatomic area affected :
Epiglottis :mainly in older child.
Laryngitis, and laryngotracheobronchitis (LTB) mainly in very young child
Tracheitis.

3. Acute epigluttitis
It is a serious obstructive inflammatory process occurs in children 2-5 years required immediate attention.
Cause agent: Haemophilus influenza.
Clinical manifestation:
Sore throat. Pain in swallowing.
Fever.
Tripod position: sitting upright, leaning forward, chin thrust out , mouth open & tongue protruding.
Drooling saliva is common and excessive secretion.
Irritable, restless anxious.
voice thick & muffed.

4. Acute epigluttitis
Suprasternal & substernal retraction __ slow quit breathing.
Cyanosis, throat red and inflamed.
Throat inspection should be attempted only when immediate intubations can be performed if needed__ hypoxia, hypercapnia, decrease PH__ Resp. acidosis__ may be death.
Therapeutic management:
Examination of throat with tongue depress is contraindication.
Entubation or tracheotomy__ if there is complete obstruction with Resp. distress.

5. Acute epigluttitis
Antibiotic therapy AB: the swelling decreases after 24 hours of AB therapy, and the epiglottis is near normal by the 3rd day.
Corticosteroids is beneficial during early hours of treatment.
Recommended: H. influenza type B conjugate vaccine is beginning at American Academy of Pediatric to given at 2 months of age 2003.
Nursing consideration:
Must be acting quietly and calmly.
Provide support without increase anxiety.
Allowed comfortable position.
Continuous monitoring of respiratory status by puls oximetry, and ABGs

6. Acute laryngitis Viruses causative agents, RSV, rhinoviruses.
Treatment is symptomatic , with fluid and humidified air.

7. Acute laryngotracheobronchitis (LTB)
The most common croup syndrome.
Affect child younger than 5 years
Causative agents: Para influenza virus, RSV, influenza A&B and mycoplasma pneumonia.
Pathophysiology: the disease is usually preceded by URTI, which ch-ch by:
Gradual onset of low-grade fever.
Inflammation of the mucosa lining of the larynx and trachea, causes narrowing of the airway.
The child struggles to inhale air past the obstruction and into the lung __ inspiratory stridor and suprasternal retraction__ hypoxia & hypercapnia & decrease PH __ Resp. acidosis__ Resp. failure.

8. Acute laryngotracheobronchitis (LTB)
Therapeutic management:
Major objective is to maintain patent airway and to provide adequate respiratory exchange.
Mild croup (no stridor at rest) manage at home with taught the parents the sign of Resp. distress.
High humidity with cool mist provides relief.
Hood O2 therapy for infant & tent O2 therapy for toddler, to provide increased humidity and O2.
Nebulizer Epinephrine__ vasoconstriction, rapid onset, repeat dose every min in PICU or 3-4 hours.
Corticosteroids__ anti-inflammatory affect__ decrees edema.
Mild croup can drink. But sever case unable to take oral fluid ,so IV fluid indication

9. Acute laryngotracheobronchitis (LTB)
Nursing consideration:
Continues observation &accurate assessment of Resp. status.
Cardio respiratory monitoring &non invasive puls oximetry.
Early sign of impending airway obstruction include:
Increase puls& resp.rate,.
Substernal, suprasernal and intercostal retraction.
Flaring nares.
Increase restlessness.
Encourage rest to conserve energy.

10. Acute laryngotracheobronchitis (LTB)
Infant & small children prefer to be hold and sit upright.
Security of child by parent's presence.
Parents need reassurance regarding their child's progress and explanation of treatment.
Home care include continued humidity & nourishment

11. Acute spasmodic laryngitis
Spasmodic croup, mid night croup.
Ch-ch by paroxysmal attacks of laryngeal obstruction that occur chiefly at night.
Signs of inflammation are absent or mild.
There is often a history of previous attack 2-5 days.
Affect children 1-3 years.
Allergies may be implicated in some cases.

12. Acute spasmodic laryngitis
Clinical manifestation:
Start with feeling mild Resp symptoms but the child awake from sleep suddenly with barking, metallic cough, hoarseness, noisy inspiration, restlessness, anxious, frightened , dyspnea, no fever.
Attack subside in few hours and child appear well next day.
Therapeutic management and nursing consideration are as LTB.

13. Bacterial tracheitis
It is an infection of mucosa of upper trachea occur in children one month to 6 years.
It is complicated of LTB.
Causes staphylococcus aurous, group AB hemolytic streptococcus, H. influenza.
Manifestation similar to LTB but unresponsive to LTB therapy .
Other symptoms is production Of thick, purulent tracheal secretion.
Treatment:
Humidification & O2 therapy, antipyretics& antibiotics.
Endotracheal intubations.
Frequent tracheal suctioning.
See table 23-1 the comparison of croup syndromes.