View source for 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===
*Epinephrine 1:1000 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 iGel
*If unable to oxygenate or ventilate with iGel place ET Tube
=====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

[[Category:EMS]]