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Respiratory Tract Infection Case Study

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Croup: A Common Upper Respiratory Tract Infection Introduction Croup accounts for 15% of clinic and ED visits for an upper respiratory tract infection and is the most common cause of acute stridor. Most often croup occurs in children ages 6-36 months of age but can be seen in older children up to age 6. Males are more prone to croup than females. Croup usually occurs in early winter and presents to the ED from 10:00PM to 4:00AM. Hospitalizations from croup usually are between 2-5% with 1% of those children requiring intubation and .5% of those intubated dying. Complications are rare but it is important to identify the treat these patients rapidly. Case Report: 4 year old female with a barking cough A 4 year old female presented to the ED at…show more content…
While these are two distinct conditions, clinically they are often overlapping. Symptoms include fever, hoarseness, a seal-like barking cough, and acute stridor. Stridor occurs from narrowing of the larynx and the trachea and is audible on inspiration, signifying an upper respiratory obstruction versus expiratory stridor which indicates a lower airway obstruction. More severe cases will have both inspiratory and expiratory stridor, signifying respiratory distress. Other signs include retractions, lethargy, agitation, tachypnea, tachycardia, hypotonia, hypoxia, and cyanosis. If these signs are present, the patient may need to be intubated. It is also important to assess the severity of the croup utilizing the Westley croup score which helps evaluate level of consciousness, cyanosis, stridor, air entry, and retractions. Mild croup with a score ≤ 2 indicates a barking cough and hoarse cry with no stridor at rest. Moderate is a score of 3-7 signifying stridor, mild retractions, other respiratory distress signs, but little or no agitation. Severe croup is a score ≥ 8, signifying significant stridor, retractions, decreased air entry, agitation, and fatigue. Impending respiratory failure is a score ≥ 12 with signs of fatigue, retractions, decreased breath sounds and consciousness, tachycardia, and…show more content…
The work-up of croup usually does not require an x-ray unless the diagnosis is still in question or a foreign body is high on the list of differentials. The findings on an x-ray show subglottic narrowing also known as the steeple sign. In epiglottitis swelling is present also known as the thumb sign, but in croup the epiglottis will be normal. Lab tests are of limited use unless it is a more severe case. Usually it is not required to determine the etiology of the croup. Treatment of croup is based on Westley croup score described above. Mild croup can be treated at home for symptom control with humidity, fever reduction, and oral fluids. Exposure to cold air or humidifiers may help to decrease the cough symptoms. Parents should be advised of the signs of respiratory distress and be called back in 24 hours to assess the status of their child. Patients in an outpatient setting can be given one oral dexamethasone dose at
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