Comments on: Perspective

By: tim ferrell

tim ferrell — Mon, 20 Feb 2012 05:51:06 +0000

Ogre: I had croup every year around Christmas time when I was a kid, until about age 11. No asthma, though. One thing that helped a lot was that my parents bundled me up in bed and opened the windows and let the cold winter air into the bedroom all night. It made a huge difference, and of course thay made sure I was warm enough in bed. Sounds too easy to be a valid strategy, but in my experience it worked wonders.

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By: Flint

Flint — Mon, 13 Feb 2012 21:19:25 +0000

That would be a damnfool bet, given that you know nothing of my background.

And if you’re “Googling up” treatments from a site for /students/, then I will question /yours/. The first thing you learn when you get out of school, is that the only real benefit school provides, is to teach you how to learn, because the real learning begins in the real world. Between myself, my wife, and my youngest brother, I think we have enough schooling for half a dozen doctors. (only my brother is currently licensed, before you ask – the rest of us have moved on as we’ve gotten older and other opportunities have presented themselves)

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By: pobrian

pobrian — Mon, 13 Feb 2012 16:21:25 +0000

Flint- thanks for your concern. Just months ago one of the ICU docs where I work gave a presentation on two croup cases, one being notable for the patient’s untimely demise. No underlying conditions. I’m sure the family would appreciate you making light of croup.
As for your evaluation of interventions- maybe you should have been there to set those Doctors straight. “more severe pathology of which croup was merely an indicator”? Croup is croup. Look it up. Yes, Croup is likely to trigger asthma symptoms in an asthmatic. Just as RSV will. Just as para influenza will.Just as cigarette smoke will. Just as allergens will. Just as inhaling fumes from solvents or paints will. Just as cold weather will. Etc. Etc. Etc. Without going into everything said earlier, and without tossing insults around, Google up treatments for croup on a site that a med student would use. NOT to be anything but objective- ER personal have no control over anything EXCEPT what takes place in the ER. IF a patient came in and showed no improvement with treatment, that pt would not be released- unless someone insisted. Documentation of treatments and outcomes supports either a need to be admitted , or able to discharge with a plan of follow up. Where I work ,numerous parents will DECLINE to have their child admitted, leaving “A.M.A.” ( Against Medical Advise )because they don’t THINK the child is that ill, usually because the kid did look better than when they brought him or her in. Again, not being anything but objective. NOT saying that happened here. Fact is, neither you nor I know for fact the totality of the circumstances; but I’d bet my life on ANY ER staff if I were choosing over their expertise or yours.

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By: Flint

Flint — Mon, 13 Feb 2012 14:52:25 +0000

I think I’ll just reiterate what he posted…

“Multiple trips to the ER where the morons there treated the asthma attacks but did jack shit about the croup which is what was triggering the asthma attacks. We finally got some stuff to control the coughing and since then we’ve had no more asthma incidences.”

Apparently, given that what they were doing was not working, they were not applying the correct treatment, by definition. Your assertion that they are treated the same is, therefore, false. Maybe they /should/ be treated the same, but since at least two different treatments were used, and there were “multiple trips” which resulted in no improvement, it’s rather clear that, whatever was used, it was not treating the problem. Hence, if you are correct, and they should be treated the same, then your evidence supports the Ogre’s conclusion regarding the skill of the techs at the ER.

And yes, of course croup can kill. I never said otherwise. I said that it is rare. A hangnail can kill; it’s just extremely unlikely. When’s the last time anyone died of croup, where there was not some other, more severe pathology of which croup was merely an indicator?

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By: pobrian

pobrian — Mon, 13 Feb 2012 00:24:46 +0000

Flint- No one here suggested that coughing would clear the virus from lung cells- it DOES open the small passages in the lungs. NO kidding, viruses live in cells. Wow. Re read listed treatments. This is what we do. You are grossly oversimplifying. “Cough” doesn’t trigger asthma symptoms, cough is ONE of many asthma symptoms,and is a primary presentation of the inflammation of airway structures in croup , being the one we can see and hear. In treatment, we have to address WHY the cough ( among other symptoms) exists. SO bronchodilators to open the airways in the lungs, steroids to reduce the inflammatory response and all that accompanies it- which ADDRESSES the CAUSE of the cough, coarse breath sounds, cough, etc. Your “apple and oranges” comparison is illogical at best. Croup (or exertion, or a camp fire, or cigarette smoke, or any respiratory virus , or someone’s perfume, or pet dander,or cold weather, or damp weather,or a dirty home, or etc, etc, etc. …any of a number of things parents have a hard time complying with because some doctors is “telling them have to live”; but I wander here ) can trigger an asthmatic reaction. WE treat them the same. A cough suppressant doesn’t do what the steroid will. Or the brochodilators. The cause of the cough is the inflammation, the body’s response. IF we merely temporarily quiet the cough- WE feel better about it, but have not addressed the INFLAMMATION of thelungs/airway which is the cause. YES croup can kill.The key is to start steroids SOON enough, and not stay at home and give over the counter cough syrup because it makes us sound better for a few hours.

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By: Eric

Eric — Sun, 12 Feb 2012 16:24:26 +0000

Glad he’s feeling better but we’ll keep him and your family in our prayers.

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By: Leon

Leon — Sun, 12 Feb 2012 16:00:55 +0000

You might check into using fish oil for asthma.
Supposed to cut inflammation which can start, or enhance asthma attacks.
Someone in my daughter’s college graduating class did as study on this for her
senior thesis. I think there are others too.

I have been using fish oil capsules for five years and it has helped me a lot.

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By: sarge712

sarge712 — Sun, 12 Feb 2012 15:43:31 +0000

I was there as a young father when my youngest daughter had heart surgery. I prayed to take away my child’s ailment and let me bear the burden. All the so-called important stuff melts away and life comes down to it’s truly essential parts. It woke me up, changed my life and made me a better dad and husband.

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By: Flint

Flint — Sun, 12 Feb 2012 14:18:39 +0000

Given that croup is viral, there’s little that can be done to “address the cause,” other than support to allow the immune system to do its job.

While coughing will remove some small percentage of infectious material, the primary viral loading is within the cells, and isn’t going anywhere due to simple coughing.

If coughing is triggering asthmatic reactions, that concern far outweighs any small benefit that would be derived from coughing out a small fraction of the viral load.

Croup is very rarely life threatening. Asthma is the far greater concern. If someone gets shot in the chest and breaks his ankle when he falls down, you don’t delay the operation on the GSW so that they can cast his ankle; the ankle can wait.

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By: pobrian

pobrian — Sun, 12 Feb 2012 12:06:38 +0000

TX for Croup AND Asthma have many identical points! IV and/or oral steroids, SVN ( aerosol breathing treatments with Racemic Epi, Albuterol, etc, etc., )supplimental oxygen if indicated. IV fluids if dehydration, antipyretics if febrile.Cool mist is still sometimes ordered, but has by and large been shown to be mostly useless. Sauce for the goose is sauce for the gander. Coughing actually serves to clear secretions from the air passages in the lungs, so most Doctors do NOT want to get rid of a cough as a front line intervention- it is entirely possible ( and ill advised) to suppress a cough without addressing the cause of the cough, which is no help to the patient. Address the cause of the cough, and the cough goes away. Make the cough go away without addressing the cause= more trouble for the patient . Before you go dismissing the folks in the ER as morons for not being able to pull a Harry Potter to restore your child’s health, maybe you should invest in some college and become a Respiratory Therapist, or an RN, and then walk in THEIR shoes for a few years.

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