It’s that time of the year in the PICU for more respiratory illnesses, one of them being croup. This is an ancient illness — its very name comes from the Anglo-Saxon word to croak, which is what children with croup can sound like. The characteristic brassy cough sounds more like a seal to our modern ears, though. Also characteristic is a sound we call stridor, the sound of air rushing through a narrowed tube, in this case the child’s airway.
Croup is caused by viral infection of the region just below the vocal cords. One of several viruses can do it, but the usual offenders are members of the parainfluenza group. The infection causes swelling, and the swelling causes narrowing of the airway. This makes it more difficult for the child to breath — in some ways it is like breathing through a straw — and the child has to work harder to get air in. This can make the child’s chest cave in the wrong way with each breath, something called retractions. Fever, if present, is usually mild.
As with most viral illnesses, there is no specific treatment for croup — what treatment we have is directed at relieving the symptoms of throat pain and difficulty breathing. We do have several effective ways of doing this. Simple mist, as from a steamy bathroom, is a time-honored therapy to help a child breath. Inhaling a mist of the drug epinephrine shrinks the swollen tissues, although it only lasts for an hour or two. The drug dexamethasone, either orally or by injection, has become a standard therapy for moderately severe croup and it is quite effective. Acetaminophen or ibuprofen can treat fever and throat pain.
When should you bring your child to the doctor for croup? A good rule of thumb is if your child has stridor when sitting quietly or if there are any retractions present — both of these are indications for therapy with epinephrine or dexamethasone.
We always see a few children in the PICU with severe croup, usually those who need repeated doses of epinephrine or are working very hard to breath. On very rare occasions we need to use a breathing tube and a mechanical ventilator for these children. Nearly all children, however, recover from croup with no complications.
I’ve written a more detailed discussion of croup, which includes an x-ray of what it looks like and some uncommon causes of airway obstruction, in a Google Knol here. (A glitch in the Google software refuses to list my name as the author; I’ve given up trying to fix it.)
Two-thirds of all internet users do Google searches to look for health information. So we shouldn’t be surprised that Google is entering the world of healthcare in a big way. A couple days ago Google Health went live. It’s still only in a beta version, but users can already give it a test drive. So what is it, exactly?
The fundamental notion is that it gives the patient, the consumer, access to (and therefore control of) the health record. A user can store in one spot all information about his health — medical records, laboratory test results, pharmacy records, and even general information about his health conditions. This last aspect is key. Your Google Health site can be a central repository about what your health needs are, what’s been done about them, and what you might or should do about them. Of course for the whole thing to work most third-parties, like hospitals, pharmacies, and doctors’ practices, have to sign on to participate. More fundamental than that, medical records need to be totally electronic so users can upload them, and at this time many, even most, are not — they’re still on paper.
Google also plans to do more than just be a search engine. Through its Knol project, it means to be a source of hard information about health issues with a whole library of signed articles by experts. I was one of the medical experts Google asked to help launch the project, which should go live later this year. I think it will be a very useful site and will generate a huge amount of traffic because all of the contributions are signed by people whose credentials you can check. It also will allow comments by readers.
One major concern about Google Health is how secure your personal health information is, and if Google (or anybody else) will use it to target marketing initiatives at you. Google says they are taking extra precautions to secure the data, but this is a serious concern. Also, as of now there is no advertising on the site, but there could be in the future. I would be concerned if Google used your personal health record to select ads targeted at you, as they do now according to what you search. You can read a general news story about the project here and an insider’s description by Dr. Bob Wachter here.
Edited to add: here’s another excellent review of what Google’s entry into healthcare might mean. It’s from Lynch Ryan’s Workers’ Comp Insider blog, and it weighs both the pros and the cons.
It’s winter in the PICU and that means more respiratory illnesses, one of them being croup. This is an ancient illness — its very name comes from the Anglo-Saxon word to croak, which is what children with croup can sound like. The characteristic brassy cough sounds more like a seal to our modern ears, though. Also characteristic is a sound we call stridor, the sound of air rushing through a narrowed tube, in this case the child’s airway.
Croup is caused by viral infection of the region just below the vocal cords. One of several viruses can do it, but the usual offenders are members of the parainfluenza group. The infection causes swelling, and the swelling causes narrowing of the airway. This makes it more difficult for the child to breath — in some ways it is like breathing through a straw — and the child has to work harder to get air in. This can make the child’s chest cave in the wrong way with each breath, something called retractions. Fever, if present, is usually mild.
As with most viral illnesses, there is no specific treatment for croup — what treatment we have is directed at relieving the symptoms of throat pain and difficulty breathing. We do have several effective ways of doing this. Simple mist, as from a steamy bathroom, is a time-honored therapy to help a child breath. Inhaling a mist of the drug epinephrine shrinks the swollen tissues, although it only lasts for an hour or two. The drug dexamethasone, either orally or by injection, has become a standard therapy for moderately severe croup and it is quite effective. Acetaminophen or ibuprofen can treat fever and throat pain.
When should you bring your child to the doctor for croup? A good rule of thumb is if your child has stridor when sitting quietly or if there are any retractions present — both of these are indications for therapy with epinephrine or dexamethasone.
We always see a few children in the PICU with severe croup, usually those who need repeated doses of epinephrine or are working very hard to breath. On very rare occasions we need to use a breathing tube and a mechanical ventilator for these children. Nearly all children, however, recover from croup with no complications.
I’ve written a more detailed discussion of croup, which includes an x-ray of what it looks like and some uncommon causes of airway obstruction, in a Google Knol here.
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