Difference between revisions of "Croup"

(Created page with "==Epidemiology== - 3 mo - 3 yrs (6-24 mo common) - fall & winter - Parainfluenza (50%), RSV, adenovirus, influenza, measles, HSV, Mycoplasma pneumonia. In non-immunized, po...")
 
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==Epidemiology==
 
==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==
 
==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
2-3 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==
 
==Work-Up==
 
+
#Consider CXR
 
+
#Consider nasal washings for RSV, parainfluenza, influenza.
Consider CXR
 
 
 
Consider nasal washings for RSV, parainfluenza, influenza.
 
 
 
 
  
 
==Treatment==
 
==Treatment==
 
 
 
CROUP SCORE (also see Med Rules)
 
CROUP SCORE (also see Med Rules)
  
I. STRIDOR
+
*STRIDOR
 
+
**0 None
    0 None
+
**1 Only c agitation
 
+
**2 Mild @ rest
    1 Only c agitation
+
**3 Severe at rest
 
+
* RETRACTIONS
    2 Mild @ rest
+
**0 None
 
+
**1 Mild
    3 Severe at rest
+
**2 Moderate
 
+
**3 Severe
II. RETRACTIONS
+
* AIR ENTRY
 
+
**0 Normal
    0 None
+
**1 Mild decrease
 
+
**2 Mod decrease
    1 Mild
+
**3 Marked decrease
 
+
* COLOR
    2 Moderate
+
**0 Normal
 
+
**1
    3 Severe
+
**2
 
+
**3 Cyanotic at rest
III. AIR ENTRY
+
* LEVEL OF CONSCIOUSNESS
 
+
**0 Normal
    0 Normal
+
**1 Restless when disturbed
 
+
**2 Restless when un-disturbed
    1 Mild decrease
+
**3 Lethargic
 
 
    2 Mod decrease
 
  
    3 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
 
 
    0 Normal
 
 
 
    1
 
 
 
    2
 
 
 
    3 Cyanotic at rest
 
 
 
V. LEVEL OF CONSCIOUSNESS
 
 
 
    0 Normal
 
 
 
    1 Restless when disturbed
 
 
 
    2 Restless when un-disturbed
 
 
 
    3 Lethargic
 
 
 
 
 
 
MANAGEMENT (Viral)
 
 
 
<4: Mild
 
 
 
    1. Mist
 
 
 
    2. Outpt
 
 
 
5-6: Mild-Mod
 
 
 
    1. Mist
 
 
 
    2. Racemic epi*
 
 
 
    3. Dexameth**
 
 
 
    4. 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
 
 
 
7-8: Moderate
 
 
 
    1. Racemic epi*
 
 
 
    2. Dexameth**
 
 
 
    3. Admit
 
 
 
>9: Severe
 
 
 
    1. Racemic epi*
 
 
 
    2. Dexameth**
 
 
 
    3. Intubtion?
 
 
 
    4. PICU
 
 
 
 
 
 
*Racemic Epi 0.25-0.75mg in 2.5ml NS
 
  
 
if 1:1,000 (L-epi) use 2.5-5.0mL (= 5mg)
 
if 1:1,000 (L-epi) use 2.5-5.0mL (= 5mg)
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DON'T USE if Cardiac Muscular Outflow Obstruction or Tetralogy of Fallot.
 
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==
 
==Spasmodic Croup==
 
 
 
-presents suddenly, without URI prodrome
 
-presents suddenly, without URI prodrome
  
 
-often resolve spontaneously before ED c cold night air, shower water vapor.
 
-often resolve spontaneously before ED c cold night air, shower water vapor.
 
 
  
 
Treatment
 
Treatment
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Racemic Epi 0.25-0.75ml in 2.5ml NS
 
Racemic Epi 0.25-0.75ml in 2.5ml NS
 
 
  
 
==Source==
 
==Source==
 
 
 
4/14/06 DONALDSON (adapted from Lampe, Rosen)
 
4/14/06 DONALDSON (adapted from Lampe, Rosen)
 
 
 
  
 
[[Category:Peds]]
 
[[Category:Peds]]

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

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

Work-Up

  1. Consider CXR
  2. 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)