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Okay. Okay, folks. So I'm just going to talk to you today at Light Crip. So just a basic introduction. Yeah, right. And so just I kind of talk will be out of a brief introduction to croup. We'll talk about a quart of differentials, not to miss well. Man review the schooling system commonly used with group. We'll discuss management options on, then talk about 20 of discharge. Passion safely was crypto. So what is script? So grip is technically me know, allows laryngo track your bronchitis, which is implementation off the firings moorings, trachea kind. It's a viral infection which is most commonly called my parents brands of virus. But it's important just to be aware that it can also be caused by a multitude of other viral infections. So in terms of croup, there several homework see choose to be aware of. So the first one level often see will be a child that has a barking cough. They may have notable strider on the horse voice. The peak incidence of Crip is two years, although can and occur and Children up to the age of 12 was an age range normally given between six months and six years, parents will describe the Chinese. Having a procedure and cries a little less is often worse at night, with symptoms come last 3 to 5 days. So just a bit of physics recap. So if you remember your posses law on this talks about the videos off the airway is half than the resistance to airflow increases. 16 fold. I'm not just indicates why and any changes in the airway in terms of it's really a super. Such is a demon are swelling or inflammation. Then they're significant, significant resistance to airflow, which can increase the child's work of breathing. On that strider a couple call apparent. So whenever we're dealing with Children, Weeks and Crip is the most likely diagnosis. It's very important not to forget about a few differentials that are red fly. It's important not to miss, so they are epiglottitis bacterial Truckee. I just and healed foreign body on the verge of reaction or anaphylaxis. I'll briefly just talk a little bit of I teach So Abigail a tightness. It's historically called by him off this influenza type B vaccinations and just in 1992. But it's very important to be aware the Children can still get him, even if they've been vaccinated. And the second commonest calls is also, um, streptococcus pneumonia. Important thing to be aware is the child look sick? Um, whenever you approach the challenge, and it's very important just to appreciate Hi on. Well, they are. And it's often characterized by the four days so drilling dyspnea, dysphagia and dyspareunia importantly, really step away from the child about point. I never look at the nice because that can cause that and the airway to click disposable. So in Children that look sick and lightness, you want to get seen your helping all the statics EMT of veal available. But you don't have the anterior calls like and these Children and often require international well, the airways and secured you can consider oxygen nebulized adrenal the antibiotics on dexamethasone. So bacterial Truckee I just and that's inflammation of the trachea and stuff, or eus is the commonest calls. Often the China will have a barking cough temperature of the sore throat, and people can sometimes makes out with crypt. But I think the big difference is that in a bacterial tracking, I just the child again looks extremely sick and it's a potential airway emergency. You want to get seeing your help, and the treatment is Katherine. It's for um, clindamycin. Was algesia further doing the line? Just ultimate is in your oral intake. So unhealed foreign bodies so within in hand, foreign body in the key thing, usually the history. These Children are otherwise well, So she's the new history of any coryza will miss the Chinese, maybe playing with his toys or leg, because it's actually the commonest and healed for body and 80 in the UK So often the child's been planning and then they're just sudden onset of Strider. History is very important in terms of the size she of a nature of the object. It's a potential airway emergency because it could be partially or two clips don't bit. Airway Senior helps needed and removal dolls dependent the patch. Um, so you may use the girls forceps if it's in their warfarin or bronchoscopy under G A. So and just moving a little bit on the town of the Lexus, and that this was covered earlier as well. By anything. It's a rapid onset, life threatening systemic hypersensitivity reaction characterized by compromise and a being out more. See and just see at the site of the screen there the guidelines and regarding out a lot, since Mom is one and you call for help by the child flat. The news, The trigger. Your big one dose is I am adrenaline and down dramatically size established the airway. Apply oxygen to get a set of ultras actions. Give a further jokes my adrenaline five minutes after the first dose and then also consider if your fullest 10 miles, particularly Children on, then that's just a little bit of reviewed out. The definite Duke since all of adrenaline and Children. If there isn't a response to the two doses of the drug one, then this refractory anaphylaxis and that's 100 different algorithm. It's just important to go think off these red fly differentials and Children presenting with potential strider, so I will just go back to grip. So their scoring system, used and crypt was called the Westlake Rip score kind of attack. Several clinical speech into kind, including the level of consciousness if cyanosis is present, Strider air Andri out attractions or work of breathing so and this could be categorized into mind moderate severe or impending spread me feel your but I think it's just feel that sometimes put this scoring system and into high the child would look with a certain score. So, for example, if it's mild crypt, the child usually do quite well. They may have occasional barky cough, but there's no strider at rest. There's either in mind our new increased work of breathing so moderate, so this would be a child with a cough. It's more of a dominant feature, maybe strider at rest with mild to moderate reflections. And but there's little a little distress or agitation so severe. So this is the China and off Descents again frequent barbeque off. They're strider at rest mark retraction on significant restrict distress on our detention and then moving on to the life threatening. Where there's a decrease level of consciousness, strider at rest, severe attractions per and drink. The finances are power. Try to be treat Crip, so I suppose the first point it's keep the child's parents come still public. Nothing happened to this key past year, and everything was was on the suggestions. So port of just do you ask me and Tom I'm taking a step wise approach. So in terms of one of the first things you get this oxygen and I ever generally would only be indicated science lesson like to 2% a little here and they were saying, and it could be considered and sides off last time we did for a patient. Now, just remember, it's a drug need to prescribe it as well, and dexamethasone is and B and staying with croup. It works very well and superior to Premise Moon. The dose will be 0.15 mg per kilogram. This come to give it early I am or some cops. And but you can also give nebulize the desert my destiny. This vomiting nebulized adrenaline is also an option that you used in the more severe life threatening and incidence of croup. It's 0.5 mils per kilo of one and one size and and on the maximum dose is five mils. It's important to note with your nebulizer. Adrenal and not alluded can work very well. The child often preached very quickly, but then then I wanted to know your is the child's come out deteriorated again. So I think whenever you're you're using that delights the general and you always want to be and the Aldactone sure that you're monitoring the child appropriately to be there to cancer, and that's what happens. So here's just a brief summary flu chart off the management of Crip. And so if you cough a child consents acute onset of strider and it looks like croup. Then you didn't want to first. Maybe the assessment child stable or unstable if their life threatening creatures such a scientific sister, decrease consciousness. If there is, then this child with automatically have a score of 11 three ply oxygen medicine is adrenaline. I'm gassy stomach help along with senior help with your Mr um colleagues any day. And but a lot of the Children that we see and do you tend to be more than find our order it. And so if the child's would be miles west like rip scores to treat zero to you and they off do very well with the single dose of oiled Accident is, um, and on discharged on words and with parental information on 15 advice. And if the child has the crypt score of three, defy such a moderate crip so often you give them one dose of oil decks, but you'll observe them for four hours and monitor response. If they've responded well that that could be discharged home. It's it's only a partial response. Then we can continue to the observe them. And if you think they have responded, but they're not fully resolved. And then sometimes there's an option of giving. I'm a further dose of oil Dex, whom to be administered on 12 hours after the drugs that you get 30 day and again alongside parental information. And but if there's no improvement in the Children with my moderate Crip, then they progress on to admission. I would never charge a chime strider at rest and again. We'll order them closely because at the V blind can occur quickly after your nebulizer. Adrenal. So what's the progress? Cyst in Crip? Through the majority off, Children are discharged home. 5% require admission. Importantly, want to 3% of all admission that required to bed, and so a little croup is usually well managed. It can be safely just to march. There is always that risk, but Children come become very on whales that there's a 0.5 percentile idiot and complications just to be aware of what could pneumonia bacterial Trumpy. I just so then discharged. See if they happen. And so if you're standing a parent's room with the child explained to return to any and if the child is any difficulty breathing and a liver are noisy breathing, if the oil in tech is doing by 50% or any drug lot based or an efficient parental concern, Thank you for listening. And I love being your questions, like so called, um, it just gets put with that time to get some questions. And if they have any, uh, really great, uh, just spray off. And these ones, I think the reason I put the Zyvox, then we're just because it's gonna be so prevalent. We think over the next few months, especially so and lots of checking points there. And hopefully you'll find something helpful because some people come in someone's is Carlos Awesome doubles. So that's a new crisis conference. Thanks so much