Difference between revisions of "Croup"

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Revision as of 06:48, 6 June 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.

CROUP SCORE

  • 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)