Prehospital protocol croup
Perform general assessment
- 100% O2 NRB
- Blow-by O2 on if need to decrease agitation
- Suction (bulb or mechanical) if excessive secretions are present
- Keep child calm while properly securing
Vital Signs
- Cardiac Monitor
- Pulse Oximetry
Stridor at Rest?
Yes
- Epinephrine1:1000 3mL in Nebulizer
Continue to Monitor
- Reassess for signs of respiratory failure
Respiratory Failure
Yes
- Attempt BVM Ventilation
- Normal Saline (weight *2 ) mL bolus IV/IO
Continue BVM
If BVM not effective perform:
- Reposition Airway
- Check correct mask size
- Check O2 source
- Place OPA
- Check gastric distention
BVM Effective?
If BVM effective then monitor and transport
- Call online medical control for further instructions
If failed BVM then:
- Place endotracheal tube or supraglottic airway
Yes
- Continue to monitor
- Reassess oxygenation and ventilation
No
Effective oxygenation and ventilation?
- EtCO2 reading
- Misting in Tube
- Equal breath sounds
- Cord visualization if intubated
Give Dexamethasone
- Give PO dexamethasone (weight *0.6)mg PO
- If child spits out the medication or unable to tolerate PO then give 0.6mg/kg IM
- If respiratory failure then give 0.6mg/kg IV
Monitor and Transport
- Rapidly transport
- Continue to monitor
- Further orders via on-line physician