Contributor: Ricky Dhaliwal, MD
Educational Pearls:
Croup
Caused by:
Parainfluenza, Adenovirus, RSV, Enterovirus (big right now)
Age range:
6 months to 3 years
Symptoms:
Barky cough
Inspiratory stridor (Severe = stidor at rest)
Use the Westley Croup Score to gauge the severity
Treatment:
High flow, humidified, cool oxygen
Dexamethasone 0.6 mg/kg oral, max 16mg
Severe: Racemic Epinephrine 0.5 mL/kg
Consider heliox, a mixture of helium and oxygen
Very severe: be ready to intubate
Bronchiolitis
Caused by:
RSV, Rhinovirus
Symptoms are driven by secretions
Symptoms:
Cough
Wheezing
Dehydration (often the symptom that makes them look the worst)
Age range:
2 to 6 months
Treatment:
Suctioning
Oxygen
IV fluids
Nebulized hypertonic saline
DuoNebs? No.
Asthma
Caused by:
Environmental factors
Viral illness with a predisposition
Treatment:
Beta agonists
Steroids
Ipratropium
Magnesium (relaxes smooth muscle)
References
Dalziel SR, Haskell L, O'Brien S, Borland ML, Plint AC, Babl FE, Oakley E. Bronchiolitis. Lancet. 2022 Jul 30;400(10349):392-406. doi: 10.1016/S0140-6736(22)01016-9. Epub 2022 Jul 1. PMID: 35785792.
Hoch HE, Houin PR, Stillwell PC. Asthma in Children: A Brief Review for Primary Care Providers. Pediatr Ann. 2019 Mar 1;48(3):e103-e109. doi: 10.3928/19382359-20190219-01. PMID: 30874817.
Midulla F, Petrarca L, Frassanito A, Di Mattia G, Zicari AM, Nenna R. Bronchiolitis clinics and medical treatment. Minerva Pediatr. 2018 Dec;70(6):600-611. doi: 10.23736/S0026-4946.18.05334-3. Epub 2018 Oct 18. PMID: 30334624.
Smith DK, McDermott AJ, Sullivan JF. Croup: Diagnosis and Management. Am Fam Physician. 2018 May 1;97(9):575-580. PMID: 29763253.
Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child. 1978 May;132(5):484-7. doi: 10.1001/archpedi.1978.02120300044008. PMID: 347921.
https://www.mdcalc.com/calc/677/westley-croup-score
Summarized by Jeffrey Olson | Edited by Meg Joyce & Jorge Chalit, OMSII