Croup - Laryngotracheitis (6 mo - 6 years)



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Croup - Laryngotracheitis (6 mo - 6 years)

1 or more factors returned?

Repeat racemic epinephrine

Consider giving IV formulation PO as it tastes much better

Dexamethasone injection

Meets discharge critiera?

Inclusion Criteria
  • Clinical symptoms consistent with croup
Exclusion Criteria
  • Toxic appearance
  • History of upper airway anatomical or functional abnormality
  • Hypotonia or neuromuscular disorder

Meets discharge criteria?

Reassessment in 1 hour

Discharge with follow up within 24 hours

Meets discharge criteria?

Reassessment in 1 hour

1 or more clinical factors returned?

1 or more clinical factors present immediately after racemic epinephrine?

  • Stridor at rest
  • Sternal wall retractions
  • Tachypnea
  • Agitation / Restlessness / Lethargy
  • Difficulty with talking or feeding

Racemic epinephrine 2.25% inhalation solution

Discharge with follow up within 24 hours

Reassessment in 1 hour

1 or more factors returned OR > 2 nebs given total?

Stridor at rest AND one other clinical factor:

  • Sternal wall retractions
  • Tachypnea
  • Agitation / Restlessness / Lethargy
  • Difficulty with talking or feeding

Consider alternative diagnosis (foreign body, epiglottitis, bacterial tracheitis, etc.)

Admit to ICU
Admit to Floor

Consider pediatric or pulmonary consult

Chest and Neck X-rays

  • No evidence that x-rays improve the treatment of croup.

Epiglottitis

  • May mimic the signs of croup

Discharge criteria

  • Minimal stridor at rest (stridor with activity expected)
  • Minimal retractions
  • 2 hours after racemic epinephrine dose
  • Reassuring vital signs
  • Tolerating PO
  • Well-appearing
  • No social/family concerns
  • Reliable follow up in 24 hours
  • Parents comfortable and understand discharge plan
  • Provider comfortable with outpatient therapy

Cool Mist

  • No evidence that cool mist improves the treatment of croup.

Spasmodic Croup

  • Occurs only at night, rarely requires medications

Respiratory Viral PCR

  • No evidence that laboratory tests improve the treatment of croup.

Bacterial Tracheitis

  • May mimic the signs of croup