Croup

Question 1

What is the initial treatment for Moderate/Severe croup? (2)

Answer 1

Dexamethasone (PO/IV/IM)
- 0.6mg/kg (Max dose 12 mg)

Racemic Epinephrine
- 0.05mL/kg @ 2.5%

Question 2

If there is improvement in stridor following racemic epinephrine administration, what is the next goal in evaluation?

Answer 2

check for recurrence of stridor WITHIN 2 hours following RE administration

• if there is recurrence –> repeat RE and restart 2 hours observation

Question 3

What are the 4 requirements for discharge of Croup patients (per CMH CPG guidelines)?

Answer 3

1. > 2 hours since last RE
2. no stridor at REST or other signs of inc. WOB
3. tolerating PO intake
4. family has access to medical care

Question 4

What is the difference between Mild and Moderate/Severe Croup?

Answer 4

Mild
- barky cough
- no stridor at rest
- no tachypnea
- minimal retractions

Moderate/Severe
- inspiratory stridor at rest
- tachypnea
- moderate/severe retractions
- hypoxemia in severe croup

Question 5

What is the difference in ED treatment for mild vs moderate/severe croup?

Answer 5

Mild = ORAL dexamethasone 0.6 mg/kg (max: 12 mg)
- discharge home following

Moderate = dexamethasone (PO/IV/IM) 0.6 mg/kg + RE 0.5 mL of 2.5%
- observe for 2 hours
> recurrence? = repeat RE and 2 hours observation
> no recurrence? = discharge criteria –> home

Question 6

What are the 4 parts of the admission criteria for Croup (per CMH CPG guidelines)?

Answer 6

1. 3+ doses of RE needed
2. persistent respiratory distress
3. severe croup without improvement after RE
4. patient not otherwise meeting D/C criteria

Question 7

What is the more specific name for Croup?

Answer 7

Laryngotracheobronchitis

Question 8

What is the most common cause of Croup?

What are 5 other viruses that can cause it?

Answer 8

Main cause = parainfluenza virus

Others: RSV, adenovirus, influenza, rhinovirus, enterovirus

Question 9

What is the typical age range for Croup and what age range does it have peak incidence in?

Answer 9

Age range: 6 months - 6 years

Peak incidence: 12 months - 2 years

Question 10

What is the most narrow part of the airway in children < 8 yo and why is it important in the setting of Croup?

Answer 10

Narrowest airway = subglottic space

• nasal/pharyngeal infection spreads to subglottic space
• cricoid cartilage cannot expand = significant narrowing secondary to inflamed mucosa

agitation leads to dynamic obstruction above/below ring = high-pitched stridor

Question 11

What scoring system is commonly used to assess Croup severity?

Answer 11

Westley scoring system

Question 12

What characteristic x-ray finding is indicative of Croup?

Answer 12

Steeple sign