Barking Benny — Croup (Laryngotracheobronchitis)
Seal-bark cough, inspiratory stridor at rest — cool mist, keep him calm
Benny wakes at 2 a.m. with a cough that sounds like a seal barking, gasping for each breath in between. His mother says he had a runny nose and low fever for two days before this.
Benny is a toddler with a viral infection that swells his subglottic airway. A barking, seal-like cough, hoarseness and inspiratory stridor develop after a few days of cold symptoms, usually worse at night. Cool mist or cool night air often eases mild stridor; racemic epinephrine and dexamethasone treat moderate-to-severe cases. Stridor at rest and retractions mean the airway is narrowing dangerously, and agitation from forcing exams or restraint makes swelling and airway obstruction worse.
Read Barking Benny's full story →The story arc
The setup
A few days of rhinorrhea and low-grade fever look like an ordinary cold in this 18-month-old.
The turn
By night his voice turns hoarse and each cough sounds like a barking seal, worse when he cries and worse in the dry night air.
The crisis
In the emergency department Benny is stridorous even at rest, sitting up and tugging to breathe, with visible suprasternal retractions.
The save
The nurse keeps him calm in his mother's lap, gives cool humidified oxygen, administers nebulized racemic epinephrine and oral dexamethasone, and watches for stridor to return after the epinephrine wears off.
NCLEX study section — Croup (Laryngotracheobronchitis)
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.