Croup
                                      =====
þ Causes of croup
 - "PAIR" Parainfluenza > RSV (opposite for bronchiolitis)

þ Bacterial Tracheitis (Membranous Croup)
 - fails racemic epi
 - not seen 1940-1970's
 - AKA mucopurulent tracheobronchitis, bacterial tracheitis, non-diptheria
   tracheitis, membranous croup
 - 18-40% mortality, 83% intubated
 - bronch is diagnostic and therapeutic
 - broad-spectrum antibiotics
  + ? Rocephin, Unasyn; add Vanco

þ Good review of viral croup:
  <Ped-Resp.TXT 3 9>

þ Recurrent croup may be caused by reflux
 - [Waki EW. The incidence of gastroesophageal reflux in recurrent croup.
   Pediatric Emergency Care 1996;12:156-160.]

þ Croup is:
 - A miscellaneous group of infections chracterized by a croupy cough.
 - main types are viral LTB, spasmodic croup, and (rarely) bacterial
   tracheitis.

þ Viral laryngotracheobronchitis ("LTB")
  - Parainfluenza I and III most common causes
  - less than 3 years
  - subglottic edema
  - usually preceding URI; waxing and waning cough
  - worse at night.
  - fever less than 102F
  - no postural preference
  - usually no drooling
  - stridor is musical, not wet like in epiglottitis

þ spasmodic croup
 - Sudden onset at night
 - young school age kids
 - no URI or fever,
 - (subglottic pallor and edema on intubation)
 - presumed allergy
 - rapid resolution.
 - Mostly resolves with just mist.

þ bacterial tracheitis
 - Preceding URI
 - rapid progression
 - severe obstruction
 - high fever
 - very toxic
 - poor response to racemic epinephrine and steroids
 - sometimes see mucous plugging in trachea on x-ray
 - purulent tracheal secretions on intubation
 - from staph, pneumococcus, H. flu.
 - Rare.
   [Donaldson JD, Maltby CC. Bacterial tracheitis in children. J
   Otolaryngology 1989;18:101-4.]
   (from Bruce Rosenthal, M.D., 1991 Sierras Emergency Care Conference,
   and from Emergency Department Law 1993;4(22):7-8.)

þ Croup Score
 <P-C-scor.TXT>

þ Treatment of Croup
  <P-C-Rx.TXT>