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