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