Sunday, October 10, 2021

Croup--Be Prepared--It's an Odd Year

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care. 

As I sit here in bed writing this post, I have eleven off-grid/survival medicine references piled up next to me. They're all the ones I usually consult, plus a few others thrown in for good measure. There was precisely one reference to croup, and it was only a mention. The author wrote nothing more about it. Maybe none of them thought it was that important. But I really believe it bears mentioning at the very least. Croup is contagious, and it occurs pretty often even now. 

Fortunately, Dr. Steve did address croup in his class. The first thing he said was that parents need to be educated to keep from freaking out. I understand that. My husband and I were a bit concerned when Queen of the Picky Eaters (QOTPE) had croup ten years ago. I suppose a considerable measure of our concern was because she did not fit the profile for having croup. Croup is typically a late fall and winter disease (QOTPE had it in the middle of summer). Croup generally afflicts young children, about six months to three years in age (she was nearly eight years old). And croup is more common in boys than girls. Oh, and it's also more common in odd-numbered years. (Yeah, that was weird, but it actually comes from an article in the Canadian Medical Association Journal.)

Croup, laryngotracheobronchitis, is usually caused by a virus. It causes swelling of the trachea and thus constricts the airway. As the area affected is around the vocal cords, laryngitis or hoarseness sometimes occurs. In more severe cases, the swelling is significant and can make it difficult to breathe, but most cases are managed without incident at home.

Beyond that, croup is typified by a loud, barking cough that is exacerbated by coughing and crying, anxiety, or agitation--basically anything that makes the child breathe more rapidly. That seal-like barking cough is key to diagnosis; without it, it's not croup. The illness usually begins like a regular cold but progresses to the seal bark cough, and often includes a fever, hoarse voice, and noisy or labored breathing, called stridor, due to the turbulent airflow in the larynx. A secondary infection can make the symptoms worse. The symptoms worsen at night and last anywhere from one to five days (three to five days per the Mayo Clinic). 

Croup afflicts about 15% of children at some point in their lives, and 1-5% of these cases are severe enough to require hospitalization. A single dose of steroids is usually administered in more severe cases. Lacking steroids, epinephrine may also be used. However, it is not systemic epinephrine; epinephrine injections are not likely to work.

Per Dr. Steve, the epinephrine needs to be on the vocal cords. He recommended putting epinephrine in a nebulizer, but to be aware that when the epinephrine wears off, there may be a rebound effect. Primatene Mist, which used to be widely used by asthmatics, was taken off the market by the FDA in 2012. It was finally reformulated with a different propellant and was back on the shelves late last year. Having this in the kit will be easier than getting epinephrine powder and putting it in the atomizer, but there is still the risk of a rebound effect. Another option he suggested was perhaps putting epinephrine powder in a teapot, 1 ml of epinephrine in 15 ml of boiling water or a teapot, and have the patient inhale the steam. Or if you have it, an essential oils atomizing diffuser. Any of these approaches would be used only when there truly is no doctor and no medical help of any kind. And the epinephrine solution needs to be directly inhaled, not merely placed by the bedside.


Other options for reducing the swelling, irritation, and coughing for milder cases include:
  • Liquid ibuprofen. Reduce the dosages and administer more frequently without ever exceeding the total daily dosage. As ibuprofen is an anti-inflammatory, you are hoping it will decrease inflammation of the trachea. If the child can gargle, dilute the ibuprofen in a little water and have her gargle it thoroughly before swallowing.
  • If outside temperatures are cold, wrap the child up well and take him outside to breathe the air. If it is not cold, open up the freezer and have the child breathe deeply. Or put ice cubes in a bowl, bend the child over the bowl with a towel over the child, and have him breathe deeply.  
  • Use a cool-mist humidifier or steam from a hot shower for ten minutes. You really want a steam room, not just some humidity by the bed.
  • Put a few drops of oregano essential oil in a pot of boiling water and have the child inhale deeply for five minutes. This is also good for calming the anxiety which often accompanies croup, especially in small children. Follow this with a cold air breathing treatment.
  • Sit upright.
  • Keep the child well hydrated. 
  • Comfort and cuddle the child to keep her as calm as possible.  

Note. Some care providers believe that there isn't actually a rebound effect with epinephrine administered for croup. Rather, the epinephrine worked for a time. But because the underlying cause of the croup was not addressed, the seal cough and stridor returned when the epinephrine wore off. As we are unlikely to have access to steroids or the decadron that is often used in emergency rooms, we would have to use something like Primatene Mist. Of course, you're not actually doing this without a doctor's supervision. You're only stocking some epinephrine to have on hand just in case.

Links to related posts:
Epinephrine
Oregano
OTC Pain Relievers (Ibuprofen) 

For further reading:
https://www.webmd.com/children/understanding-croup-basic-information
https://www.mayoclinic.org/diseases-conditions/croup/symptoms-causes/syc-20350348
https://kidshealth.org/en/parents/croup.html
https://www.whattoexpect.com/childrens-health-and-safety/croup-in-children.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796596/
https://www.tapatalk.com/groups/respiratorytalk/racemic-epinephrine-rebound-t638.html
https://breathe.ersjournals.com/content/15/1/e1

 27 october 2019

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