Hi and welcome to Nursing School Explained. Today we'll cover another
respiratory disorder that affects children which is called croup or this
mouthful: laryngotracheobronchitis or also LTB. Now just think about what
this means: Laryngo pertains to the larynx,
trachea pertains to the trachea and bronchioles refers to the to the
bronchioles. And then -itis is inflammation. So this is basically
inflammation of the upper airway: larynx trachea and the upper airway bronchioles.
Now then there's a special case which is epiglottitis. It does fall into these
croup-type disorders but it's a little bit different and we'll discover your
why shortly. Now epiglottitis is basically inflammation of the epiglottis,
which is the part that closes off the trachea when we swallow and eat. So when
there's a lot of inflammation there that can be a lot of lot of problems. So now
knowing that we have upper airway inflammation here, well first of all
let's go over the causes. So typically croup or laryngotracheobronchitis is
caused by the parainfluenza virus, typically occurs in winter months
like most pediatric respiratory disorders, boys are higher have a higher
prevalence than girls, and the age range is usually six months to six years old.
Where epiglottitis is a little bit different it's caused by a bacteria,
which is him Haemophilus influenzae type B and because this
such a significant or can be such a significant problem with an airway
obstruction, we now vaccinate children against Hib so if the patient is
typically on a normal vaccination schedule, then the risk for them to to
get Hib should be relatively low. But because we're dealing with this upper
airway inflammation signs and symptoms include inspiratory stridor. So
this will be the narrowing of the airway that we can hear and is typically the
sound that that's it's pretty significant and a lot of times can be
heard with just a naked ear without even using a stethoscope and it sounds
something like e-e-e, this sound that that's pretty significant and should hint
you, give you hints that there's something going on with the patient's
airway. Now because of we have all this inflammation here the patient might be
complaining of a sore throat, they might have a hoarse voice, and then they might
have this, and I put all quotes here, "harsh", " brassy", "croupy" or "seal-like"
cough. So croupy cough and that is something also that once you've heard it
it's really very easily distinguishable, and it's very loud, and it does sound
like a seal if you ever heard a seal bark before. A lot of times it'll be
accompanied by high fever, agitation and then any of those signs and symptoms of
respiratory distress because the airway might be partially occluded. So nasal
flaring or retractions, trachel tugging, any of those signs and symptoms.
Now for epiglottitis, and I have this color coded here so typically the croup
symptoms are in black and then epiglottitis whatever is special about
that I put here in pink. So for epiglottitis we have the
four Ds which is drooling, dysphasia, dysphonia, and distress. So these are a
little bit more significant symptoms, and the patient might be drooling
because they are unable to handle their secretions. So their airway is so swollen
that they cannot even swallow their own saliva, which is definitely a red flag. If
you ever see a patient drooling and they can't handle their secretions there's
there's immediate interventions are needed. So the four Ds here. Then for our
Diagnostics so usually croup is diagnosed based on
symptoms with this inspiratory stridor, sore throat, and in this typical cough
that we usually experience. We are only going to do a nasal swab if the airway
is open so we don't want to put anything in the patients nose or mouth to
even inspect the posterior pharynx if we think that there's inflammation
going on or swelling. Because we know that children sometimes are not very
cooperative with their exam and even if just a slight touch of the back of the
throat or even with the nasal swab can cause some increased inflammation and
swelling and completely occlude the patient's airway. So very very careful
here. In the case of suspected epiglottitis the patient is going to get
an x-ray or CAT scan of the soft tissue of the neck to see the extent of the
swelling and airway obstruction. They might need a chest x-ray to see if
there's anything else going on, if their suspicion for pneumonia or atelectasis.
And if they have epiglottitis they will usually be
admitted so they'll get some basic blood work, CBC, metabolic panel as well as
blood cultures because we want to find out if the infection might have been
spread systemically. Now our treatment and nursing care here is pretty
self-explanatory if we have upper airway concerns we always want to make sure
that we maintain a patent airway by whatever means possible. And that
includes having intubation equipment readily available
at the bedside because if there is something getting worse we can't be
scrambling for this equipment, we need to have it right there at the bedside. Cool,
humidified air or oxygen is always a good idea when there's any kind of upper
Airways swelling because the coolness of the air and the coolness of the oxygen
will help with the edema of the swollen airway. Now something that we tell
parents in the home care of their children when they have some sort of
croup sometimes it gets worse at night and so that they don't end up in
the ER or some home remedy that the parents can do is either take the
patient outside into the cool air or turn on the shower with cold water only
and that steam that will be coming although it's only cold water but we
still some extra moisture and coolness in the air that will help to decrease
the airway swelling. Now certainly if that doesn't help then they need to
call 911 and go to the closest emergency room to deal with this potential airway
obstruction. Children will need to be hydrated because they are drooling, they
have dysphonia, dysphagia, they can't swallow, they can't talk
so IV hydration is going to be very important. We already talked about intubation
equipment. And then for medications I'm going to underline this here also so
this racemic epinephrine is a treatment for both croup and
epiglottitis and what it is is an inhaled version of an epinephrine. And
what it does it broncodilates and it dilates the entire airway therefore
reducing the swelling or the narrowing of the airway
and allows the patient to breathe easier. Now this medication can only be given at
the hospital and it requires very strict observation of the patient because when
they receive this medicine they might get better very quickly and the parents
will think oh my child is fine I can go home now, but they might have
rebound swelling and rebound inflammation once that medicine wears off. So they'll
keep these patients in the ER for two to three hours after the treatment to see
how they are doing and if they require two multiple doses of this epinephrine
inhaled then they might need to stay at the hospital for close observation. Now
when there is epiglottitis then the patient will require IV fluids again
because they're not going to be able to swallow and stay hydrated and we know
that that's a huge issue in the pediatric population. As well as IV
antibiotics remember we said it's caused by a bacteria so the only way to fight
that is with antibiotics. And then a lot of times they will get IV steroids as
well or sometimes after the initial period they'll be transitioned to PO
steroids and a lot of times that is Dexamethasone. So in summary just
think about where the inflammation takes place. In this case if it's in the larynx,
trachea or bronchioles or the epiglottis we have to worry about the airway
because of all the swelling that occurs here. Signs and symptoms are pretty
self-explanatory if you know what is causing the problem. So thank you for
watching this summary of croup and epiglottitis. Please watch for all of the
other pediatric respiratory disorders in the playlist here and I will see you
next time. Thank you for watching Nursing School Explained!