Croup Flashcards
Most common viral cause of croup?
parainfluenza virus
What croup disease features indicate need for evaluation in the ED or by doctor?
Stridor at rest
Rapid progression of symptoms
Inability to tolerate fluids
Known underlying airway issues that predispose to complications (airway narrowing, neuromuscular diseases)
Previous episodes of severe croup or intubation
Drooling or inability to swallow
What are the findings in croup that are most predictive of hospitalization?
Degree of chest retractions and amount of air entry
What are the features of moderate to severe croup?
Moderate: Stridor at rest, at least mild retractions and other signs of respiratory distress, but no agitation
Severe: loudness of stridor may decrease due to decreased air movement, severe retractions, anxious, agitated, or pale and fatigued
What signs in croup might indicate impending respiratory failure?
lethargic, fatigued and listless marked retractions (or decreased retractions from fatigue) decreased or absent breath sounds decreased consciousness tachycardia out of proportion to fever cyanosis or pallor
What is the name of the croup severity score?
Westley Croup severity score
What are home remedies for mild croup?
Steam in bathroom Humidifier Fluid intake Antipyretics Cool night air
What is the management of mild croup in the ED?
Everyone gets steroid, Epi is for most severe
Single dose of steroids (shortens course): 1mg/kg of prednisone or 0.15-0.6mg/kg of Dex PO/IV/IM
Epi is usually not needed
Ensure they can tolerate fluids
Give guidance on return precautions
What is a defining difference between moderate and severe croup?
Agitation in addition to worsening respiratory distress
How is severe croup managed?
Avoid agitating the child and have the parent hold and comfort them
Epinephrine early
Dexamethasone PO/IV/IM
What is the dosing for recemic epinephrine?
- 25mL for <20Kg
0. 5mL for >20Kg
When can a croup patient go home after treatment?
If given recemic epi, they should be observed for 2-3 hours to ensure they don’t have recurrence
Before use of steroids, there was a rebound phenomena after the epi wore off, but this doesn’t really happen anymore because of steroid use
What croup kids get admitted?
If requiring 2 or more doses of epi
What should thought process be if not responding to epi and steroids?
Widen your differential!
Think of airway anomalies, other conditions, and consider referring to ENT
