Dexamethasone Flashcards
What clinical situation would indicate a need for Dexamethasone?
Mild, moderate and severe/life-threatening childhood croup
What is croup?
a common upper respiratory condition/infection in children, typically between 6 months and 3 years
Why does croup require treatment? (2)
Croup causes inflammation in the upper airways
Children have smaller airways than adults, when inflamed your airway becomes narrower, making it harder to breathe - the smaller the child, the less tolerance to swelling they have before life threatening
What is Dexamethasone and why is it used to treat croup? (2)
Dexamethasone is a corticosteroid which decreases vasodilation and capillary permeability whilst inhibiting the accumulation of inflammatory cells
It has been shown to reduce symptoms of croup within two hours and shorten hospital stays
Inclusion criteria for Dexamethasone administration?
Children aged 1 month to 10 years with mild, moderate or severe/life-threatening croup
What two scores can be used to help define severity of croup? (2)
Modified Taussig Croup Score
Westley Croup Score
Exclusion criteria for Dexamethasone administration? (3)
Systemic infection/sepsis
Hypertension
Known hypersensitivity to dexamethasone or any excipient
Cautions for Dexamethasone administration? (4)
Upper airways compromise can be worsened by any procedure distressing the child, including the administration of medicine
Immunocompromised children. Ensure they have access to tertiary centre input and have contacted their local team for advice. A single dose of dexamethasone will not usually impact on their subsequent care
If an alternative diagnosis is considered most likely refer to Bronchiolitis and Croup or Respiratory Emergencies in Children Clinical Guidelines
Subsequent doses - Where a child has been given a corticosteroid previously by a different clinician a repeat dose may be given where clinically indicated such as a deterioration in clinical condition.
How and how much dexamethasone should you administer? (3)
Oral solution
Single dose
Refer to page for age for exact doses
Is the administration of Dexamethasone a PGD?
Yes
What Clinical Publication Category is Dexamethasone?
Mandatory (Red) No deviation from document permissible
What referrals / safety netting should be provided when discharging on scene after Dexamethasone administration? (2)
Ensure that there is a communication to the patient’s registered GP to inform them about the consultation, the outcomes of that consultation and any treatment given
Parent/carers of children left at home must be told to seek further medical advice if the child becomes generally unwell, if there is no improvement within 48hrs or if there is a deterioration in their condition.
What advice should you give parents about the management of croup? (6)
Explain treatment
Take particular care to avoid exposure to measles or chickenpox and to seek immediate medical advice if exposure occurs.
Croup is self-limiting and symptoms usually resolve within 48 hours, although occasionally they may last for up to a week.
Resolution of croup symptoms is usually followed by symptoms of upper respiratory tract infection - refer to Clinical Guideline for worsening advice to give to parents
Explain that decongestants and short-acting beta-agonists (salbutamol) are not effective. Saline nasal drops may help if child congested.
Croup is usually a viral illness and antibiotics are not needed
