croup journal presentasi

7/23/2019 Croup Journal Presentasi

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REVIEW

CROUP IN CHILDRENCanadian Medical Associaton Journal

Candice L. Bornson MD! Da"id W. Jo#nson MD

Octo$er %&! '(%)

Pe*$i*$in+, dr. C#ristian Harr-! /.0H0

Disusun ole#, Mic#ael Ant#onius Li*


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Introduction

1 E/ide*iolo+-1 More t#an 2(.((( Canadian c#ildren eac# -ear 'nd*ost co**on

cause o3 res/irator- distress in c#ildren

1 Bo-s 4 5irls 6%.7,%8

1 Co**onl- on -oun+ c#ildren 69 *ont#s : ) -ears8

1 Clinical *ani3estation1 A$ru/t onset o3 $ar;- cou+#! ins/irator- stridor! #oarseness! and

res/irator- distress

1 Preceded $- '7


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Introduction

1 Etio/at#o+enesis1 Viral in3ection o3 res/irator- tract, Hu*an /arain3luen>a "irus % )

6*ostl-8! in3luen>a A B! res/irator- s-ncitial "irus! r#ino"irus!

corona"irus! #u*an *eta/neu*o"irus! adeno"irus

1 Ede*a in3la**ation o3 t#e u//er air?a- lar-n+eal *ucosa narro?in+ in su$+lottic re+ion o3 t#e air?a-

1 tatistics1

') /atients #a"e *ild s-*/to*s1 %


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Pur/ose o3 re"ie?

1Address t#e dia+nosis and *ana+e*ent o3 crou/ in

c#ildren! s/eci3icall- 3ocusin+ on clinical assess*ent o3

disease se"erit- to +uide *ana+e*ent decisions


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W#en s#ould crou/ $e sus/ected

1 C#ild ?it# classic si+ns s-*/to*s1 A$ru/t onset o3 $ar;- cou+#! ins/irator- stridor! #oarseness

1 Preceded $- '7


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Cou+# in crou/


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Di33erential dia+nosis

Bacterial trac#eitis1 Acute! /otentiall- li3e


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E/i+lottitis1 Unco**on since HiB "accination

1 A$ru/t onset o3 d-s/#a+ia! droolin+! aniet-! 3e"er

1 No $ar;- cou+#

1 C#ild /re3ers to sit in an u/ri+#t /osture*aintain sni33in+ /osition

1 Ris; 3or /ro+ression to co*/lete air?a- o$struction

1 0reat*ent1 Monitor air?a-

1 Anti$iotic $road


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1 0rac#eal or eso/#a+eal 3orei+n $od-1 Histor- o3 in+estion or c#o;in+ o3 3orei+n $od-

1 No #oarseness! $ar;- cou+#! /rodro*al s-*/to*s

1 Retro/#ar-n+eal or /eritonsillar a$scess1 tridor! d-s/nea! torticollis! d-s/#a+ia! nec; /ain! or sti33ness! and

cer"ical l-*/#adeno/at#-

1 No $ar;- cou+#

1Aller+ic reaction or acute an+ioede*a1 Ra/id onset o3 u//er air?a- o$struction and stridor! si+ns o3 aller+-

6urticarial s;in ras#8


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W#at in"esti+ation! i3 an-! is needed

1 Viral cultures and ra/id anti+en testsnot needed

1 Radio+ra/#ic in at-/ical /atients1 Frontal, narro?in+ o3 t#e su$+lottic s/ace 6ste//le si+n8

1 A$sence o3 t#is si+n doesnGt rule out crou/


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Radio+ra/#ic in"esti+ation

1 In $acterial trac#eitis and e/i+lottitiscan a+itate

c#ildren and tri++er acute air?a- o$struction

1 E/i+lottitis, a$nor*all- t#ic;ened e/i+lottis and ar-tenoe/i+lottic

3olds

1 Retro/#ar-n+eal a$scess, $ul+in+ so3t tissue o3 t#e /osterior

/#ar-n+eal ?all

1 Bacterial trac#eitis, irre+ular trac#eal *ucosa! or strands /roectin+

into or across t#e trac#eal lu*en


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1core ' , *ild crou/

1 core )


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Corticosteroid

1 Data1 Decreased E0 intu$ation $- &

1 Reduced len+t# o3 #os/ital sta- $- %)

1 Reduced return *edical "isits $- %'

1 E33ects1 Reduce res/irator- distress ?it#in %# o3 oral ad*inistration

1 E33ects increasin+ 3or at least %(# a3ter ad*inistration

1 Mec#anis* o3 action1 Anti


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Corticosteroid

1 Route1 Oral, dea*et#asone or /rednisolone

1 Ne$uli>ed, $udesonide

1 Intra*uscular, dea*et#asone

1 Dru+ o3 c#oice, Dea*et#asone1 tandard


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Ne$uli>ed e/ine/#rine

1 Data1 Clinical i*/ro"e*ent in crou/ score )(* 3ollo?n+ ad*inistration

1 #orter len+t# o3 sta-

1 E33ects1 Ra/id! s#ort


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Ne$uli>ed e/ine/#rine

1 Race*ic e/ine/#rine '.'&@ 6(.& *l in '.& *l saline8

1 L


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Ot#er /#ar*acot#era/ies

1 al$uta*ol 6selecti"e ' a+onist81 Unli;el- to re"erse t#e narro?in+ o3 t#e u//er air?a- $ecause it

doesnGt contain s*oot# *uscle

1Anti$iotics1 Unli;el- to s#orten t#e duration o3 s-*/to*s $ecause crou/ is

caused $- a "iral in3ection

1 Helio1 Miture o3 lo?


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1 Indication o3 ad*ission1 Persistent stridor and c#est ?all indra?in+ 47# a3ter treat*ent ?it#

corticosteroids

1 ociode*o+ra/#ic or conditional 3actors,

1 ParentsG de/endence on /u$lic trans/ort! li"in+ a lon+ distance 3ro**edical care and incle*ent ?eat#er

1Indication o3 disc#ar+e1 No stridor or c#est indra?in+ at rest


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Contro"ersies in treat*ent and +a/s in ;no?led+e

1 Corticosteroiddru+ o3 c#oice 3or c#ildren ?it# crou/ in

all le"els o3 se"erit-1 0#e *ost e33ecti"e dose ran+e

1 Bene3it o3 re/eated doses in *ore se"ere crou/

1 E/ine/#rine te*/orar- relie3 o3 u//er air?a-

o$struction in *ore se"ere cases o3 crou/1 #o?n to $e ine33ecti"e and conseuentl- rarel- used in acute care

settin+


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Conclusion

Decreasin+ #ealt# care costs ?#ile i*/ro"in+ c#ildrenGsoutco*es and lessenin+ t#e $urden o3 t#e disease on

c#ildrenGs 3a*ilies

Decrease intu$ations! #os/ital ad*issions and return"isits 3or *edical care

0reat*ent o3 all c#ildren ?it# crou/ ?it# corticosteroidsand t#ose ?it# se"ere res/irator- distress ?it# ne$uli>ed

e/ine/#rine


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0#an; -ou

croup journal presentasi

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