False croup (pseudocroup)

Description:

False croup — the acute inflammatory process of a throat which is followed by hypostasis of its subdepository area which leads to a stenosis of a throat and obstruction of upper respiratory tracts. The false croup is shown by the dry "barking" cough, a hoarse voice and the inspiratory asthma causing noisy breath. Weight of a condition of patients with a false croup depends on degree of a stenosis of a throat and often changes during the day. The false croup thanks to characteristic clinic and an auskultativny picture in lungs, and also to analysis findings of BRAIDS of blood, a research of gas composition of blood, a laringoskopiya, a X-ray analysis, a bakposev, PTsR and IFA-diagnosis is diagnosed. Treatment of patients with a false croup is carried out by antibiotics, antibechic, sedative, antihistaminic and glucocorticoid drugs.

Reasons of a false croup (pseudocroup):

The false croup develops as a result of narrowing of a respiratory way to areas of a throat.

Reasons of a false croup:
local inflammatory diseases (laryngitis, quinsy);
acute infectious diseases (measles, scarlet fever, flu);
allergic reactions;
local injuries (hematomas, foreign bodys);
organism diseases (heart troubles, lungs, kidneys, vessels).

Acute stenosis of a throat at adults – the unusual occurrence which is usually appearing against the background of diphtheria.

Symptoms of a false croup (pseudocroup):

In most cases the false croup develops for 2-3 days of an acute infectious disease of upper respiratory tracts. There is a triad of signs, typical for a croup: ringing cough of the barking character, an osiplost of a voice and a stridor — the noisy breath caused by narrowing of a gleam of a throat. The inspiratory type of an asthma is observed. The child is excited and uneasy. Degree of fervescence depends on a type of the activator and a condition of reactivity of an organism. It can be subfebrile condition (more often at a parainfluenza infection) and rise temperature to 40 °C (it is preferential at flu). Survey of the child with a false croup often reveals increase in cervical lymph nodes (lymphadenitis). At a breath the whistling dry rattles can be listened.

Clinical displays of a false croup directly depend on throat stenosis degree.

The I degree of a stenosis is characterized by existence of an asthma only at an exercise stress and nervousness of the child. Auscultation finds the extended breath and existence in lungs of the single whistling rattles appearing preferential on a breath.

The II degree of a stenosis differs in existence of an asthma and at rest. On a breath retraction of a jugular pole and intercostal spaces is observed. Auskultativno listens dry rattles. There is a cyanotic coloring of a nasolabial triangle testimonial of easy air hunger. Tachycardia, excitement, sleep disorders is noted.

III degree of a stenosis. Severe inspiratory short wind with retraction takes place during breath of a jugular pole, mezhreberiya and epigastric area. At the patient with a false croup the expressed "barking" cough is noted, the dysphonia and paradoxical breath develops. An asthma of the mixed character which is an adverse sign in respect of the forecast of a disease is possible. Cyanosis has diffusion character. Pulse threadlike with losses on a breath, tachycardia. The concern of the child is replaced by block, drowsiness, there is a confusion of consciousness. In lungs on a breath and on an exhalation dry and wet mixed rattles are listened, the priglushennost of cordial tones is noted.

The IV degree of a stenosis is characterized by absence of the typical for a false croup "barking" cough and noisy breath. Arrhythmic shallow breathing, arterial hypotonia, bradycardia is observed. Spasms are possible. Consciousness of the patient is confused with a false croup and passes into a hypoxemic coma. The false croup with the IV degree of a stenosis can end with a lethal outcome in a consequence of development of asphyxia.

Distinctive feature is that the false croup proceeds with changes of weight of an obstructive syndrome and inspiratory asthma for days from sharply expressed to almost imperceptible. However the greatest weight of a state is noted always at night. There are attacks of a false croup caused by the expressed throat stenosis at night. They are shown by the progressing feeling of suffocation, fear and motive concern from the child, severe short wind, characteristic cough, perioral cyanosis and pallor of other integument.

Classification:

Depending on an etiology allocate a viral and bacterial false croup. On existence or lack of complications the false croup is divided on complicated and uncomplicated.

But most often in clinical practice the false croup is classified by throat stenosis degree. At the compensated stenosis (the I degree) an inspiratory asthma (difficulty of a breath) at concern or an exercise stress is noted. The false croup with the subcompensated stenosis (the II degree) is followed by an inspiratory asthma not only at loading, but also at rest. The Dekompensirovanny stenosis (the III degree) is characterized by the heavy inspiratory or mixed asthma, paradoxical breath can be observed. At a false croup with terminal degree of a stenosis (the IV degree) the heavy hypoxia leading of the patient to death takes place.

Diagnosis:

To define how to treat a false croup, the pediatrician will see off:
- faringoskopiya;
- laringoskopiya;
- survey of a nose;
- auscultation of lungs;
- roentgenoscopy of nasal bosoms.

Treatment of a false croup (pseudocroup):

The main task of treatment of the child with a false croup is the prevention and stopping of attacks of a stenosis of a throat, removal of an inflammation and puffiness of subdepository area. It is necessary to exclude influence of factors which can provoke emergence of an attack. It is necessary to provide access of fresh air and plentiful alkaline drink, to cancel reception of the food irritating a throat, whenever possible to give to the patient with a false croup of medicine in the form of syrups, to apply the tablets softening a throat to a rassasyvaniye, aerosols and inhalations. The false croup which is followed by unproductive cough is the indication to purpose of antibechic medicines (коделак, codeine, колдрин, Noscapinum, Tusuprexum, libexinum). Use antihistaminic drugs (Diazolinum, Dimedrol, Phencarolum) having antibechic and antiedematous effect. The false croup with the expressed stenosis of a throat is treated using glucocorticoid drugs, sedative and antispastic means. Reception of antibiotics is recommended from the first day of a disease of a bacterial false croup or at development of infectious complications. Therapy of a false croup of the virus nature is carried out by antiviral drugs.

The attacks accompanying a false croup are caused by a reflex spasm of a throat and can be stopped by attempts to cause an alternative reflex. For this purpose it is necessary to press on a language root, provoking an emetic reflex, or to tickle in a nose, causing reflex sneezing. Also apply hot foot baths, warm compresses on area of a throat and a breast, banks on a back.

Forecast:

Timely diagnosed false croup has the favorable forecast and against the background of adequately carried out therapy usually comes to an end with an absolute recovery. The false croup which treatment was begun in a decompensation stage can be followed by heavy complications and pass into the end-stage which is often terminating in a lethal outcome.