Both Croup and Epiglottitis are inflammatory conditions capable of impairing the upper airway. Though different by nature, both croup and epiglottitis present with similar signs and symptoms, making it difficult for EMS personnel to differentiate between the two. In this article, we will discuss the differences in these conditions and how to treat and manage them.
Croup is an acute form of laryngotracheobronchitis, which is inflammation of the larynx, trachea, and bronchi (and also a ridiculously long word). Croup commonly occurs in infants and children ages 6 months to 6 years and is characterized by low-grade fever, barking cough, hoarseness, and stridor. Stridor is a common symptom of both croup and epiglottitis and is a loud, high-pitched sound indicative of airflow traveling through a narrow space. Croup commonly develops as a result of a viral infection, specifically of the parainfluenza virus. Croup is more common in children due to the rather small size of the airway, in contrast to the larger size of an adult airway. When a child's airway swells up due to inflammation, the reduction in diameter of the airway greatly reduces airflow. However, when an adult airway swells up, the diameter is still large enough to allow substantial airflow. Treatment of croup is typically supportive and requires placing the patient in a position of comfort and administering humidified oxygen if available. If the patient presents with severe respiratory distress, treatment should involve administration of racemic epinephrine and/or dexamethasone, according to protocol, to reduce the swelling. We say this all the time, always follow your local protocols.
Epiglottitis is a more severe form of upper airway inflammation characterized by the swelling of the epiglottis. It is caused by a bacterial infection from the H. influenza type B bacteria (Hib). In recent decades, epiglottitis has become very rare due to immunization efforts. However, the rate of immunizations in children has begun to decline as people become complacent about vaccinating their children. Children who do not receive proper immunizations greatly increase their risk of epiglottitis. Typically, epiglottitis presents with an acute onset of high-grade fever, sore throat, and drooling. Patients with epiglottitis may also experience pain when swallowing (odynophagia) or inability to swallow (dysphagia) as the airway becomes more inflamed. As the diameter of the airway decreases due to inflammation, stridor may develop. Patients should be rapidly transported to the hospital in the tripod or sniffing position to allow maximum airflow. Do not attempt to insert objects in the mouth or try to examine the oropharynx as this may irritate the airway and cause more inflammation. If respiratory failure looks imminent, provide ventilations using a BVM. In the worst case scenario, the epiglottis will get so inflamed that it will result in complete airway obstruction. In this case, attempt to intubate, but understand that it will be difficult due to the swollen tissues and trauma during the intubation may cause more complications. If intubation is unsuccessful, surgical cricothyrotomy is indicated. In infants, needle cricothyrotomy is the preferred method due to the small size of the trachea. Again, these are generalizations for the industry. Always follow your local protocols.