A 2 yr old child is brought to emergency at 3 am with fever, barking cough and stridor only while crying. The child was able to drink normally. On examination, respiratory rate is 36/min and temperature is 39.6C. What will be your next step
Dexamethasone The child is suffering from croup. Croup is the most common form of acute upper respiratory tract obstruction. It is also called laryngotracheobronchitis which is the viral infection of the glottic and subglottic region. Clinical features:? Most patients initially have an upper respiratory tract infection with some combination of rhinorrhoea, pharyngitis and mild cough and low grade fever for 1-3 days. After this upper airway obstruction becomes apparent. The child then develops the characteristic barking cough, hoarseness and inspiratory stridor. Symptoms are characteristically worse at night and often recur with decreasing intensity for several days and resolve completely within a week. Agitation and crying greatly aggravates the signs and symptoms. The child may prefer to sit up in bed or be held upright. Croup is a disease of the upper airway and alveolar gas exchange is usually normal. It is a clinical diagnosis and does not require a radiograph of the neck. Radiographs of the neck may show the typical subglottic narrowing or "steeple sign" of croup on the posteroanterior view. Croup Mild disease Occasional barking cough No stridor at rest Mild or nonexistent suprasternal or subcostal retractions Moderate disease Frequent cough Audible stridor at rest Visible retractions Little distress or agitation Severe disease Frequent cough Prominent inspiratory (and occasionally, expiratory) stridor Conspicuous retractions Decreased entry on auscultations Treatment of Croup Cornerstone of treatment Glucocoicoids Nebulized epinephrine Glucocoicoids are useful in -- Mild - Moderate and - Severe croup Dexamethasone is the most effective coicosteroid Nebulized epinephrine Useful in Moderate to severe distress (works by adrenergic stimulation, which causes constriction of the precapillary aerioles, thereby decreasing capillary hydrostatic pressure. This leads to fluid resorption from the interstitium and improvement in laryngeal mucosal edema). Antibiotics are not indicated cool mist (used earlier) Heliox (mixture of oxygen and helium. It has low viscosity and low specific gravity which allow for greater laminar airflow through the respiratory tract. Complete blood counts and culture - Is of no use in croup because it is a clinical diagnosis, this would be helpful in case of acute epiglotitis but not croup. Nasal washing for influenza & respiratory syncitial virus - Is not required since the time we would get the repo the condition would have been taken care off.
Racemic epinephrine nebulisation
Dexamethasone
Nasal wash for influenza or respiratory syncytial virus
Antibiotics and blood culture