TUTORIAL: RESPIRATORY
DISORDER
Presentation By:
Aman Yadav
Abhishek Rawat
Chinmay Bandu Tathe
Chirag
Chayan Nath
Abdul Rashid Kinattingal Pattani Sec- 3A 1
Ashishsingh Bharatsingh Rajput
Case
A 4 year old child with difficulty of breathing
was seen at the ER. His parents said that the
child was apparently well the day before but
when he woke up this morning the child was
noted to have cough accompanied by a high
pitch sound while inhaling. He was also noted
to have developed fever but the temperature
was not taken. His voice was also noted to be
different. He has no history of allergies.
Questions:
1. What is the diagnosis?
2. What is the expected PE findings in this
patient?
3. What is the differential diagnosis
4. Management
Diagnosis
The sudden onset of symptoms, along with the age of
the child and the absence of a history of allergies,
align with typical presentations of croup
(laryngotracheobronchitis)
What is Croup?
Croup is a common viral infection that primarily
affects children, causing inflammation of the upper
airway, including the larynx and trachea. The
symptoms described in the case, such as a barking
cough, high-pitched sound on inhalation (stridor),
and a change in voice, are characteristic of croup.
Signs and Symptoms
1. Barking Cough: A distinctive cough that sounds like
a barking seal, often more pronounced at night.
2. Stridor: A high-pitched sound heard during
inhalation, resulting from the narrowed upper airway.
3. Respiratory Distress: Labored breathing or difficulty
breathing, especially with increased effort to inhale.
4. Fever: The child may develop a fever, although the
degree can vary.
5. Change in Voice: Hoarseness or a different quality in
the child's voice may be noticeable.
6. Irritability: The child may appear more irritable or
fussy, especially when experiencing discomfort during
breathing.
7. Worsening Symptoms at Night: Croup symptoms
often worsen in the evening or during the night.
Pathophysiology
Croup is often caused by viral infections, with the
parainfluenza virus being a common culprit. The infection
leads to inflammation of the upper airway, particularly the
larynx (voice box) and trachea (windpipe). This
inflammation can result in swelling of the airway lining
and increased mucus production.
As a consequence, the narrowed airway makes it more
difficult for the child to breathe, leading to symptoms such
as a barking cough and stridor (high-pitched sound on
inhalation). The characteristic cough and other symptoms
are a result of the body's attempt to compensate for the
restricted airflow.
In some cases, the inflammation can extend into the
Differential Diagnosis
1. Epiglottitis: This is a bacterial infection causing
inflammation of the epiglottis, leading to rapid onset
of severe respiratory distress.
2. Foreign Body Aspiration: Inhalation of a foreign
object into the airway can cause similar symptoms
and respiratory distress.
3. Viral Bronchiolitis: Although more common in
infants, viral infections like respiratory syncytial virus
(RSV) can cause wheezing and breathing difficulties.
4. Bacterial Tracheitis: A bacterial infection of the
trachea, which may present with symptoms
resembling croup but tends to be more severe.
Diagnostic Tests
1. Physical Examination: A thorough examination, including
assessing the child's breathing, lung sounds, and any visible
signs of respiratory distress.
2. Chest X-ray: This may be done to evaluate the condition of
the lungs and airways, helping rule out conditions like
pneumonia or the presence of a foreign body.
3. Viral Testing: If a viral infection is suspected, a respiratory
viral panel or specific tests for common viruses like
parainfluenza may be conducted.
4. Blood Tests: Complete blood count (CBC) and inflammatory
markers may provide additional information about the presence
of infection.
5. Throat Culture: In cases where bacterial infection like
streptococcus is suspected, a throat culture may be performed.
6. Pulse Oximetry: Measures the oxygen saturation of the blood,
providing information about the child's respiratory status.
7. Bronchoscopy: In certain cases, especially if there is concern
about a foreign body, a bronchoscopy may be performed to
visualize and remove any obstruction.
Management
1. Nebulized Epinephrine: This can be administered in a hospital
setting to rapidly reduce airway inflammation and improve
breathing.
2. Oral or Inhaled Corticosteroids: These may be prescribed to
reduce airway inflammation. Oral dexamethasone is commonly
used.
3. Humidified Air: Breathing moist air can help relieve symptoms.
This can be achieved using a humidifier or by taking the child into
a bathroom with a steamy shower.
4. Fluids and Nutrition: Ensuring the child stays hydrated is
important. If oral intake is difficult, intravenous fluids may be
administered in severe cases.
5. Pain and Fever Management: Acetaminophen or ibuprofen may
be used to alleviate discomfort and reduce fever.
Thank You
