Croup - Symptoms, Signs, Diagnosis, Treatment of Croup
Symptoms, signs, diagnosis, treatment of croup
Croup is an acute inflammatory disease with localization in the upper respiratory tract, which is most often caused by a type 1 parainfluenza virus. It is characterized by barking cough and noisy breathing with difficulty in breathing. The diagnosis is usually obvious on the basis of clinical data, but can be confirmed by radiography of the neck in the anteroposterior projection. Treatment includes antipyretics, hydration, inhalation of racemic adrenaline through a nebulizer and glucocortico-dy. The prognosis is favorable.
Etiology of croup
Croup is primarily found in children from 6 months to 3 years. Prague-rypp viruses, especially type 1, are the main causative agents. Less frequently, RSV and influenza viruses cause respiratory tract activity, but clinical manifestations cannot be differentiated from viral croup, and spastic croup is often triggered by a viral infection.
The diagnosis is usually obvious due to the nature of the cough. Similar symptoms are observed in epiglotitis, bacterial tracheitis, foreign body, diphtheria and pharyngeal abscess. Epig-lottite, zygopharyngeal abscess and bacterial tracheitis have a more rapid onset and cause more severe intoxication, dysphagia and less pronounced symptoms of upper respiratory tract infection. A foreign body can lead to the development of respiratory failure and a typical lobar cough, however, an increase in body temperature and previous infection of the upper respiratory tract are absent. Diphtheria excludes an adequate vaccination history, is confirmed by the discovery of the pathogen in viral cultures from co-braces from typical grayish diphtheria films.
If the diagnosis is unclear, a radiography of the neck and chest should be performed in the anteroposterior and lateral projections; narrowing under the epiglottis in the picture in the anteroposterior projection confirms the diagnosis. Patients in serious condition, who should think about epiglotis, should be examined in the operating room by an appropriate specialist,able to restore airway patency. Patients should be treated with pulse oximetry, and in the presence of respiratory failure, determine the gas composition of the blood.
Prognosis and treatment of croup
The disease usually lasts for 3-4 days and is independently resolved. Children in a state of moderate severity can be treated at home, should provide them with sufficient hydration and antipyretics. It is important that the child is comfortable, as weakness and crying can worsen, followed by adenoviruses, enteroviruses, rhinoviruses and measles virus, and Mycoplasma pneumoniae. Croup caused by the influenza virus can be especially severe and can develop in children of different age groups.
Seasonal outbreaks often occur: cases of croup caused by the parainfluenza virus are more likely to occur in the autumn; caused by RSV and the influenza virus in winter and spring. Transmission occurs usually through air or in contact with infected secretions.
Infection causes inflammation of the larynx, trachea, bronchi, bronchioles and pulmonary parenchyma. Obstruction develops due to edema and exudation and is clearly manifested in the subpharyngeal space.Obstruction increases the work expended on breathing; rarely fatigue of the respiratory muscles leads to the development of hypercapnia. In parallel, atelectasis may develop if bronchiolar obstruction occurs.
Symptoms and signs of croup
The occurrence of croup is usually preceded by symptoms of an acute upper respiratory tract infection. Then, often at night, there is a barking, often spastic cough and hoarse voice; may experience inspiratory dyspnea. A child may wake up in the middle of the night with signs of respiratory failure, tachypnea, and contraction of pliable places in the chest. In severe cases, cyanosis may appear with increasingly shallow breathing.
Clear signs of respiratory failure and noisy breathing with difficulty in breathing are the most vivid manifestations of croup. Auscultation reveals prolonged inhalation, often with the presence of expiratory moist and wheezing. There may be areas of weakened breathing due to atelectasis. An increase in body temperature is noted in about1/2patients. The condition of the child may seem better in the morning and deteriorate again at night.
Repeated episodes are often called spastic croup.The role in his development may have an allergy or hyperreach state of the child. Devices for air humidification can reduce dryness of the upper respiratory tract.
Increased or persistent respiratory failure, tachycardia, weakness, cyanosis or hypoxemia, or dehydration indicate the need for hospitalization. To assess the state and its monitoring using bullet-oximetry. If the saturation O decreases less than 92%, a moistened O should be applied. Usually 30–40% concentration of O in the inhaled air is sufficient. A delay of CO usually indicates a weakness of the respiratory muscles and the need for tracheal intubation, this is also indicated in the inability to maintain oxygenation.
Adrenaline 5-10 mg in 3 ml of saline solution after 2 hours through a nebulizer causes a significant improvement and the disappearance of respiratory muscles fatigue.
At the same time, this effect is temporary; its use does not affect the course of the disease, viral infection and Rao; tachycardia and other side effects may occur.
High doses of dexamethasone can be effective in patients hospitalized with moderate and heavy croup.High doses of gluco-corticoid through the nebulizer were also used, but were not more effective. The role of glucocorticoids in the treatment of croup in ambulatory patients has not been clearly proven. Aerosols are often used at home by families, but their benefits have never been proven.
Viruses that, as a rule, cause croup, usually do not predispose to stratification of a bacterial infection, and antibiotics are rarely prescribed.
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