Difference between revisions of "Croup"
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==Spasmodic Croup== | ==Spasmodic Croup== | ||
+ | ===Background=== | ||
-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=== |
− | |||
Outpt | Outpt | ||
− | + | *cool mist / cool air / shower vapor | |
− | cool mist / cool air / shower vapor | + | *2- 4 ml Nebulized NS or |
− | + | *Racemic Epi 0.25-0.75ml in 2.5ml NS | |
− | 2- 4 ml Nebulized NS or | ||
− | |||
− | Racemic Epi 0.25-0.75ml in 2.5ml NS | ||
==Source== | ==Source== |
Revision as of 00:55, 29 May 2011
Contents
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
Background
-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)