Trainee Advanced Clinical Practitioner Diary- Day 13 - Critical Care Practitioner

Trainee Advanced Clinical Practitioner Diary- Day 13

Croup, non steroidal anti inflammatories.

Abrupt onset of a barking cough, inspiratory stridor, hoarseness and respiratory distress due to upper airway obstruction.

Other signs and symptoms may include coryzal symptoms, pahryngeal erythema and an increased respiratory rate. As the condition progresses there may be nasal flaring, suprasternal and intercostal recessions.

75% of infections caused by parainfluenza virus, peak incidence within the second year of life.

Symptoms usually resolve within 48 hours.

Use of croup score  will guide care:


None- 0

On crying/exertion- 1

At rest- 2

Severe/biphasic- 3


None- 0

On crying/exertion- 1

At rest- 2

Severe- 3

Admit if stridor at rest and/or CROUP score > 3

Treated using dexamethasone (150mcg/kg stat) if considered necessary.

Possible differentials include tracheitis, inhaled foreign body, epiglottitis, angiodema.

Once dexamethasone is administered then children need to be observed to assess its effects.

Tracheitis is commonly caused by staphylococcus aureus. This is a potentially very serious condition in children due to the relatively small size of the trachea.

Inhibit the action of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) and so the synthesis of prostaglandins and thromboxanes. Inhibiting COX-2 leads to the anti inflammatory, analgesic and antipyretic effects. Aspirin, which through its action on COX-1, inhibits platelet aggregation (why it is given in IHD) may also cause GI bleeding.




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