CROUP Flashcards
MANAGEMENT
AIRWAY/BREATHING
Trial high-flow oxygen by nasal cannula in lieu of intubation.
Have smaller endotracheal tubes available because of the potential for a narrowed airway.
Medications
CIRCULATION
95% of all cardiac arrests in children have a respiratory etiology.
IV fluids at a bolus dose of 20 mL/kg should be administered and repeated to the goal of adequate perfusion, hemodynamic stability, and improved mental status.
Blood pressure may be normal in children, even those in shock.
Septic shock from viral etiology is far less common, but possible.
If stridor present keep child as calm as possible
Frequent reassessment
Steroids for ALL: Dexamethasone 0.6 mg / kg PO, IM if unable to tolerate PO. Takes 4 hours for full effect.
Nebulized epi for moderate to severe cases:
Racemic epi = 0.05 ml / kg max 0.5 ml of 2.25% diluted to 3 mL total volume with NS. Given over 15 min. Rapid onset, lasts < 2 hrs.
L-epi = 0.5 ml / kg max 5 ml of of a 1 mg / ml solution. Given over 15 min. Rapid onset, lasts < 2 hrs.
INVESTIGATIONS
No useful labs
Soft tissue neck xray when diagnosis is in doubt
DISPOSITION
Discharge 3-4 hours after last epinephrine if no deterioration
Repeated dosing of epineprhine requires admission
DOCUMENTATION
URTI and mild fever prodrome
Classic Features:
Barky cough
High Pitched inspiratory stridor
Hoarse voice
Wheezing may occur but is usually mild
Onset often at night with stridor and respiratory distress
WESTLEY SCORE
XRAY SOFT TISSUE NECK
Steeple appearance of subglottic trachea on AP view
DDX
And DDX if <6 months
Anaphylaxis
Angioedema
Foreign Body
Bacterial Tracheitis
Epiglottitis
Retropharyngeal / Parapharygeal / Peritonsillar Abscess
<6 months think thracheomalacia
Bronchiolitis
Pneumonia
Asthma
CHF
Myocarditis
Malignancy
