Croup: Difference between revisions
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===Croup Score=== | ===Croup Score=== | ||
Inspiratory stridor | *Inspiratory stridor | ||
**None 0 points | |||
**When agitated 1 points | |||
**On/off at rest 2 points | |||
**Continuous at rest 3 points | |||
*Retractions | |||
**None 0 points | |||
**Mild 1 points | |||
**Moderate 2 points | |||
**Severe 3 points | |||
*Air entry Normal 0 points | |||
**Decreased 1 points | |||
**Moderately decreased 2 points | |||
**Severely decreased 3 points | |||
*Cyanosis | |||
**None 0 points | |||
**When crying 2 points | |||
**At rest 3 points | |||
*Alertness | |||
**Alert 0 points | |||
**Restless, anxious 2 points | |||
**Depressed 3 points | |||
'''Assessment''' | |||
*<2 Very mild | |||
*2-9 Mild to moderately severe | |||
*>9 Severe croup | |||
Assessment | |||
<2 Very mild | |||
2-9 Mild to moderately severe | |||
>9 Severe croup | |||
==Work-Up== | ==Work-Up== |
Revision as of 15:57, 4 July 2011
Background
- Croup = laryngotracheobronchitis
- Affects 6 mo-3 yr (peak in 2nd year)
- Fall & winter
- Etiology
- Parainfluenza (50%), RSV, rhinovirus
- Consider diphtheria if not immunized
- Parainfluenza (50%), RSV, rhinovirus
- Must rule-out foreign body
Diagnosis
- 1-2 day of URI followed by barking cough, stridor
- Low-grade fever
- NO drooling or dysphagia
- Duration = 3-7d, most severe on days 3-4
Croup Score
- Inspiratory stridor
- None 0 points
- When agitated 1 points
- On/off at rest 2 points
- Continuous at rest 3 points
- Retractions
- None 0 points
- Mild 1 points
- Moderate 2 points
- Severe 3 points
- Air entry Normal 0 points
- Decreased 1 points
- Moderately decreased 2 points
- Severely decreased 3 points
- Cyanosis
- None 0 points
- When crying 2 points
- At rest 3 points
- Alertness
- Alert 0 points
- Restless, anxious 2 points
- Depressed 3 points
Assessment
- <2 Very mild
- 2-9 Mild to moderately severe
- >9 Severe croup
Work-Up
- Consider CXR if concerned about alternative dx
- Steeple sign on AP (not Sp, not Sn)
- Consider nasal washings for RSV, parainfluenza, influenza.
Treatment
- Steroids
- Give to all pts with croup
- Dexamethasone 0.15-0.6mg/kg PO/IM (max 10mg)
- Give to all pts with croup
- Epineprhine (nebulized)
- Give for moderatate-severe cases
- Do NOT give albuterol (may worsen edema (vasodilation))
Disposition
- Consider discharge if:
- 3hr since last epinephrine
- Able to tolerate PO
- Nontoxic apperance
Source
Tintinalli