Difference between revisions of "Croup"
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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 | |
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− | 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