 Hi and welcome to nursing school explained. Today we'll cover another respiratory disorder that affects children which is called group or this mouthful laryngeal tracheal bronchitis or also LTB. Now just think about what this means laryngeal pertains to the larynx, tracheal pertains to the trachea and bronchioles refers to the to the bronchioles and thenitis is inflammation. So this is basically inflammation of the upper airway larynx trachea and the upper airway bronchioles. Now then there's a special case which is epiglottitis. It does fall into these group type disorders but it's a little bit different and we'll discover here why shortly. Now epiglottitis is basically inflammation of the epiglottis which is the part that closes off the trachea when we swallow and eat. So when there's a lot of inflammation there there can be a lot of a lot of problems. So now knowing that we have upper airway inflammation here, well first of all let's go over the causes. So typically group or laryngeal trachea bronchitis is caused by the parainfluenza virus typically occurs in winter months like most pediatric respiratory disorders. Boys have a higher prevalence than girls and the age range is usually six months to six years old. Where epiglottitis is a little bit different it's caused by a bacteria which is hip hemophilus influenza type B and because this is such a significant or can be such a significant problem with an airway obstruction we now vaccinate children's against hip. So if the patient is typically on a normal vaccination schedule then the risk for them to get hip should be relatively low. But because we're dealing with this upper airway inflammation signs and symptoms include inspiratory striders. This will be the narrowing of the airway that we can hear and it's typically the sound that that's that's pretty significant and a lot of times can be heard with just a naked ear without even using a set of skull but it sounds something like ee ee ee this sound that that's pretty significant and should hint you give you hints that there's something going on with the patient's airway. Now because of we have all this inflammation here the patient might be complaining of a sore throat they might have a hoarse voice and then they might have this and I will put all quotes here harsh brassy creepy or seal like cough. So creepy cough and that is something also that once you've heard it it's really very easily distinguishable and it's very loud and it does sound like a seal if you ever heard a seal bark before. A lot of times it'll be accompanied by high fever agitation and then any of those signs and symptoms of respiratory distress because the airway might be partially occluded. So nasal flaring or retractions straight out tugging any of those signs and symptoms. Now for epiglottitis and I have this color coded here so typically the group symptoms are in black and then epiglottitis whatever is special about that I put here in pink. So for epiglottitis we have the four D's which is drooling, dysphagia, dysphonia and distress. So these are a little bit more significant symptoms and the patient might be drooling because they're unable to handle their secretion. So their airway is so swollen that they cannot even swallow their own saliva which is definitely a red flag. If you ever see a patient drooling and they can't handle their secretions their immediate interventions are needed. So the four D's here. Then for our diagnostics so usually croup is diagnosed based on symptoms with this inspiratory strata sore throat and then this typical cough that we usually experience. We are only going to do a nasal swab if the airway is open so we don't want to put anything in the patient's nose or mouth to and even inspect the posterior pharynx if we think that there's inflammation going on or swelling because we know that children sometimes are not very cooperative with their exam and even if just a slight touch of the back of the throat or even with the nasal swab can cause some increased inflammation and swelling and completely occlude the patient's airway. So very very careful here. In the case of suspected epiglotitis the patient is going to get an x-ray or CAT scan of the soft tissue of the neck to see the extent of the swelling and airway obstruction. They might need a chest x-ray to see if there's anything else going on if there's suspicion for pneumonia or adolescences and if they have epiglotitis they will usually be admitted so they'll get some basic blood work CBC metabolic planar as well as blood cultures because we want to find out if the infection might have been spread systemically. Now our treatment and nursing care here is pretty self-explanatory. If we have upper airway concerns we always want to make sure that we maintain a patent airway by whatever means possible and that includes having intubation equipment readily available at the bedside because if there's something getting worse we can't be scrambling for this equipment we need to have it right there at the bedside. Cool humanified air or oxygen is always a good idea when there's any kind of upper airway swelling because the coolness of the air and the coolness of the oxygen will help with the edema of the swollen airway. Now something that we tell parents in the home care of their children when they have some sort of croup sometimes it gets worse at night and so that they don't end up in the ER or some home remedy that the parents can do is either take the patient outside into the cool air or turn on the shower with cold water only and that steam that will become and although it's only cold water there will be still some extra moisture and coolness in the air that will help to decrease the airway swelling. Now certainly if that doesn't help then they need to call 911 or go to the closest emergency room to deal with this potential airway obstruction. Children will need to be hydrated because they are drooling they have dysphonia and dysphagia they can swallow they can talk so IV hydration is going to be very important we already talked about intubation equipment and then for medications I'm going to underline this here also so this um erosinic epinephrine is a treatment for both croup and epiglottitis and what it is is an inhaled version of an epinephrine and what it does it broncho dilates and it dilates the entire airway therefore reducing the swelling or the narrowing of the airway and allows the patient to breathe easier. Now this medication can only be given at the hospital and it requires very strict observation of the patient because when they receive this medicine they might get better very quickly and the parents will think oh my child is fine I can go home now but they might have rebound swelling and rebound inflammation once that medicine wears off so they'll keep these patients in the ER for two to three hours after the treatment to see how they are doing and if they require two multiple doses of this epinephrine inhaled then they might need to stay at the hospital for close observation. Now when there is epiglottitis then the patient will require IV fluids again because they're not going to be able to swallow and stay hydrated and we know that that's a huge issue in the pediatric population as well as IV antibiotics remember we said it's caused by a bacteria so the only way to fight that is with antibiotics and then a lot of times they will get IV steroids as well or sometimes after the initial period they'll be transitioned to P.O. steroids and a lot of times that is dexamethasone. So in summary just think about where the inflammation takes place in this case if it's in the larynx trachea or bronchiose or the epiglottis we have to worry about the airway because of all the swelling that occurs here signs and symptoms are pretty self-explanatory if you know what is causing the problem. So thank you for watching the summary of croup and epiglottitis. Please watch for all of the other pediatric respiratory disorders in the playlist here and I will see you next time. Thank you for watching Nursing School Explained.