Croup: Difference between revisions

Revision as of 00:54, 29 May 2011

Epidemiology

3 mo - 3 yrs (6-24 mo common)
fall & winter
Parainfluenza (50%), RSV, adenovirus, influenza, measles, HSV, Mycoplasma pneumonia.
In non-immunized, poss Diphtheria --> give Erythromycin IV & Diphtheria antitoxin
6pm to 6am
Spasmodic croup age 1-5yrs

Diagnosis

r/o Foreign Body
2-3 day hx URI, then abrupt onset barking cough
Inspiratory Stridor
low fever 37.7 - 38.8
NO drooling or dysphagia
lasts 3 - 5 days, up to 1 wk
Steeple sign on AP (25% epiglotitis can show this too)

Work-Up

Consider CXR
Consider nasal washings for RSV, parainfluenza, influenza.

Treatment

CROUP SCORE (also see Med Rules)

STRIDOR
- 0 None
- 1 Only c agitation
- 2 Mild @ rest
- 3 Severe at rest
RETRACTIONS
- 0 None
- 1 Mild
- 2 Moderate
- 3 Severe
AIR ENTRY
- 0 Normal
- 1 Mild decrease
- 2 Mod decrease
- 3 Marked decrease
COLOR
- 0 Normal
- 1
- 2
- 3 Cyanotic at rest
LEVEL OF CONSCIOUSNESS
- 0 Normal
- 1 Restless when disturbed
- 2 Restless when un-disturbed
- 3 Lethargic

MANAGEMENT (Viral)

<4: Mild
- Mist
- Outpt
5-6: Mild-Mod
- Mist
- Racemic epi^
- Dexameth^^
- Outpt if (after 3hr OPs):
  - Improved in ED
  - >6 mo old
  - Reliable family
  - No rest stridor
  - Access to F/U
  - Benign PMH
  - VS nl
7-8: Moderate
- Racemic epi^
- Dexameth^^
- Admit
>9: Severe
- Racemic epi^
- Dexameth^^
- Intubtion?
- PICU

^Racemic Epi 0.25-0.75mg in 2.5ml NS

if 1:1,000 (L-epi) use 2.5-5.0mL (= 5mg)

May repeat Q20-30 min x 3

DON'T USE if Cardiac Muscular Outflow Obstruction or Tetralogy of Fallot.

^^Dexamethasone 0.6 mg/kg IV/IM/PO ^^^Intubation: Use ET tube 1-2 sizes smaller than usual (swelling)

Spasmodic Croup

-presents suddenly, without URI prodrome

-often resolve spontaneously before ED c cold night air, shower water vapor.

Treatment

Outpt

cool mist / cool air / shower vapor

2- 4 ml Nebulized NS or

Racemic Epi 0.25-0.75ml in 2.5ml NS

Source

4/14/06 DONALDSON (adapted from Lampe, Rosen)

@@ Line 1: / Line 1: @@
 ==Epidemiology==
+* 3 mo - 3 yrs (6-24 mo common)
+* fall & winter
-- 3 mo - 3 yrs (6-24 mo common)
+* Parainfluenza (50%), RSV, adenovirus, influenza, measles, HSV, Mycoplasma pneumonia.
+*In non-immunized, poss Diphtheria --> give Erythromycin IV & Diphtheria antitoxin
-- fall & winter
+* 6pm to 6am
+* Spasmodic croup age 1-5yrs
-- Parainfluenza (50%), RSV, adenovirus, influenza, measles, HSV,
-Mycoplasma pneumonia.
-In non-immunized, poss Diphtheria --> give Erythromycin IV & Diphtheria antitoxin
-- 6pm to 6am
-- Spasmodic croup age 1-5yrs
 ==Diagnosis==
+#r/o Foreign Body
+#2-3 day hx URI, then abrupt onset barking cough
-r/o Foreign Body
+#Inspiratory Stridor
+#low fever 37.7 - 38.8
--3 day hx URI, then abrupt onset barking cough
+#NO drooling or dysphagia
+#lasts 3 - 5 days, up to 1 wk
-Inspiratory Stridor
+#Steeple sign on AP (25% epiglotitis can show this too)
-low fever 37.7 - 38.8
-NO drooling or dysphagia
-lasts 3 - 5 days, up to 1 wk
-Steeple sign on AP (25% epiglotitis can show this too)
 ==Work-Up==
+#Consider CXR
+#Consider nasal washings for RSV, parainfluenza, influenza.
-Consider CXR
-Consider nasal washings for RSV, parainfluenza, influenza.
 ==Treatment==
 CROUP SCORE (also see Med Rules)
-I. STRIDOR
+*STRIDOR
+**0 None
-None
+**1 Only c agitation
+**2 Mild @ rest
-Only c agitation
+**3 Severe at rest
+* RETRACTIONS
-Mild @ rest
+**0 None
+**1 Mild
-Severe at rest
+**2 Moderate
+**3 Severe
-II. RETRACTIONS
+* AIR ENTRY
+**0 Normal
-None
+**1 Mild decrease
+**2 Mod decrease
-Mild
+**3 Marked decrease
+* COLOR
-Moderate
+**0 Normal
+**1
-Severe
+**2
+**3 Cyanotic at rest
-III. AIR ENTRY
+* LEVEL OF CONSCIOUSNESS
+**0 Normal
-Normal
+**1 Restless when disturbed
+**2 Restless when un-disturbed
-Mild decrease
+**3 Lethargic
-Mod decrease
-Marked decrease
+==MANAGEMENT (Viral)==
+*<4: Mild
+** Mist
+** Outpt
+*5-6: Mild-Mod
+** Mist
+** Racemic epi^
+** Dexameth^^
+** Outpt if (after 3hr OPs):
+*** Improved in ED
+*** >6 mo old
+*** Reliable family
+*** No rest stridor
+*** Access to F/U
+*** Benign PMH
+*** VS nl
+*7-8: Moderate
+** Racemic epi^
+** Dexameth^^
+** Admit
+*>9: Severe
+** Racemic epi^
+** Dexameth^^
+** Intubtion?
+** PICU
-IV. COLOR
+^Racemic Epi 0.25-0.75mg in 2.5ml NS
-Normal
-Cyanotic at rest
-V. LEVEL OF CONSCIOUSNESS
-Normal
-Restless when disturbed
-Restless when un-disturbed
-Lethargic
-MANAGEMENT (Viral)
-<4: Mild
-. Mist
-. Outpt
--6: Mild-Mod
-. Mist
-. Racemic epi*
-. Dexameth**
-. Outpt if (after 3hr OPs):
-          a. Improved in ED
-          b. >6 mo old
-          c. Reliable family
-          d. No rest stridor
-          e. Access to F/U
-          f. Benign PMH
-          g. VS nl
--8: Moderate
-. Racemic epi*
-. Dexameth**
-. Admit
->9: Severe
-. Racemic epi*
-. Dexameth**
-. Intubtion?
-. PICU
-*Racemic Epi 0.25-0.75mg in 2.5ml NS
 if 1:1,000 (L-epi) use 2.5-5.0mL (= 5mg)
@@ Line 163: / Line 83: @@
 DON'T USE if Cardiac Muscular Outflow Obstruction or Tetralogy of Fallot.
+^^Dexamethasone 0.6 mg/kg IV/IM/PO
+^^^Intubation: Use ET tube 1-2 sizes smaller than usual (swelling)
-**Dexamethasone 0.6 mg/kg IV/IM/PO
-***Intubation: Use ET tube 1-2 sizes smaller than usual (swelling)
 ==Spasmodic Croup==
 -presents suddenly, without URI prodrome
 -often resolve spontaneously before ED c cold night air, shower water vapor.
 Treatment
@@ Line 191: / Line 100: @@
 Racemic Epi 0.25-0.75ml in 2.5ml NS
 ==Source==
 /14/06 DONALDSON (adapted from Lampe, Rosen)
 [[Category:Peds]]