Croup and Bronchiolitis Clinical Review

Comprehensive vocabulary flashcards covering the symptoms, diagnosis, and management protocols for pediatric Croup and Bronchiolitis according to the lecture transcript.

Croup

The most common cause of upper airway obstruction in children, characterized by an acute onset of barky cough with or without stridor.

Parainfluenza virus

The causative agent responsible for approximately $75\%$ of Croup cases.

Steeple sign

The characteristic X-ray finding associated with Croup.

Typical Croup Age Range

Children between $6$ months and $5$ years, with a peak incidence around $2$ years of age.

Trisomy 21 (in Croup context)

A risk factor for severe Croup due to pre-existing reduced airway tone.

Key Differentiating Findings for Croup Severity

1) Stridor, 2) indrawing, 3) level of consciousness (LOC), and 4) oxygenation.

Croup Dexamethasone Dosage

A single dose of $0.6\,mg/kg$ (maximum $12\,mg$) given per oral (PO) to all children with Croup in the ED.

Nebulized Epinephrine (Croup)

Used in episodes of SEVERE croup to provide transient improvement in upper airway obstruction; patients must be observed for at least $2$ hours after treatment.

Mild Croup

Characterized by no stridor (or soft only with activity) and no indrawing (or mild only with activity); managed with a single dose of PO dexamethasone and discharge without ED observation.

Moderate Croup

Characterized by persistent stridor and mild to moderate indrawing at rest with $O_2$ sat $> 92\%$; managed with PO dexamethasone and observation for $2-4$ hours.

Severe Croup

Characterized by biphasic stridor, severe indrawing at rest, and agitation; treated with PO dexamethasone and $5\,mg$ nebulized epinephrine.

Impending Respiratory Failure (Croup)

Severe Croup signs plus altered LOC, markedly decreased air entry, cyanosis, and $O_2$ sat $< 92\%$ at rest.

PMU Admission Criteria (Croup)

Persistence of stridor at rest/respiratory distress $> 4$ hours after dexamethasone and repeated epinephrine, or barriers to returning to the ED.

PICU Admission Criteria (Croup)

Persistent severe croup despite dexamethasone and $2$ doses of nebulized epinephrine, or impending respiratory failure at any time.

Bronchiolitis

A common lower respiratory tract viral illness typically caused by respiratory syncytial virus (RSV) occurring in the late fall and winter months.

Bronchiolitis Age Group

Children less than $2$ years of age, most commonly infants younger than $12$ months.

Clinical Signs of Bronchiolitis

Runny nose, cough, wheezing, crackles, increased respiratory effort, and fevers.

Severe Bronchiolitis Risk Factors

Age $< 2$ months, history of prematurity, presence of cardio-respiratory disease, and immunodeficiency.

Bronchiolitis Supplemental Oxygen Threshold

Necessary only if oxygen saturations are persistently $< 90\%$ while the patient is awake.

High-flow nasal cannula (HFNC) Dose

A dosage of $2\,L/kg/min$ considered for individuals who fail standard oxygen therapy in Bronchiolitis.

Nebulized Epinephrine Dose (Bronchiolitis)

Trialed to improve clinical severity scores at $3\,mg$ ($3\,mL$) for patients $< 10\,kg$ and $5\,mg$ ($5\,mL$) for patients $> 10\,kg$.

Nebulized Hypertonic Saline

A treatment using $3\% NaCl$ ($4\,mL$) that may slightly shorten hospitalizations for Bronchiolitis; should be trialed once.

Bronchiolitis Clinical Course

Symptoms typically peak around day $5$ of the illness, and the cough may persist for $3-4$ weeks.