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Croup
Inclusion Criteria
  • Previously healthy
  • Age 6 months - 6 years
Exclusion Criteria
  • Toxic appearance
  • Symptoms suggestive of alternate diagnosis
  • Known upper airway abnormality
  • Hypotonia or neuromuscular disorder

Discharge criteria:

  • Minimal stridor at rest
  • Minimal retractions
  • Able to talk or feed without difficulty

MODERATE

  • Stridor at rest

SEVERE

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

MILD

  • Barky cough
  • No stridor at rest
  • None or mild work of breathing

References:

Dobrovoljac M, Geelhoed GC. 27 years of croup: an update highlighting the effectiveness of 0.15 mg/kg of dexamethasone. Emerg Med Australas 2009; 21(4): 309-14.

Geelhoed GC, et al. Efficacy of small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ 1996; 313 (7050): 140-2.

  • Dexamethasone 0.6 mg/kg (max dose 16 mg)
  • Observe every hour for 2 hours

Inpatient Management:

  • If stridor at rest: Repeat racemic Epi 2.25% inhalation solution (0.5 mL nebulized) diluted in 3 mL NS.

Admission criteria:

  • Continued stridor at rest
  • Patients requiring 2 or more doses of racemic Epinephrine
  • Requiring supplemental oxygen

Notify MD

  • Repeat racemic Epi
  • Consider alternative diagnosis
  • Consider blood gas
  • Consider transfer to PICU

Not recommended:

  • Cool mist
  • Viral PCR
  • Radiographs, unless atypical presentation or no response to therapy
  • Repeat Dexamethasone

  • Dexamethasone 0.6 mg/kg (MAX 16 mg)
  • Racemic epinephrine 2.25% inhalation solution (0.5 mL nebulized) in 2 mL NS




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