Croup

Epidemiology

- 3 mo - 3 yrs (6-24 mo common)

- fall & winter

- Parainfluenza (50%), RSV, adenovirus, influenza, measles, HSV,

Mycoplasma pneumonia.

In non-immunized, poss Diphtheria --> give Erythromycin IV & Diphtheria antitoxin

- 6pm to 6am

- Spasmodic croup age 1-5yrs

r/o Foreign Body

2-3 day hx URI, then abrupt onset barking cough

Inspiratory Stridor

low fever 37.7 - 38.8

NO drooling or dysphagia

lasts 3 - 5 days, up to 1 wk

Steeple sign on AP (25% epiglotitis can show this too)

Consider CXR

Consider nasal washings for RSV, parainfluenza, influenza.

CROUP SCORE (also see Med Rules)

I. STRIDOR

    0 None

    1 Only c agitation

    2 Mild @ rest

    3 Severe at rest

II. RETRACTIONS

    0 None

    1 Mild

    2 Moderate

    3 Severe

III. AIR ENTRY

    0 Normal

    1 Mild decrease

    2 Mod decrease

    3 Marked decrease

IV. COLOR

    0 Normal

    3 Cyanotic at rest

V. LEVEL OF CONSCIOUSNESS

    0 Normal

    1 Restless when disturbed

    2 Restless when un-disturbed

    3 Lethargic

MANAGEMENT (Viral)

<4: Mild

    1. Mist

    2. Outpt

5-6: Mild-Mod

    1. Mist

    2. Racemic epi*

    3. Dexameth**

    4. Outpt if (after 3hr OPs):

         a. Improved in ED

         b. >6 mo old

         c. Reliable family

         d. No rest stridor

         e. Access to F/U

         f. Benign PMH

         g. VS nl

7-8: Moderate

    1. Racemic epi*

    2. Dexameth**

    3. Admit

>9: Severe

    1. Racemic epi*

    2. Dexameth**

    3. Intubtion?

    4. PICU

if 1:1,000 (L-epi) use 2.5-5.0mL (= 5mg)

May repeat Q20-30 min x 3

DON'T USE if Cardiac Muscular Outflow Obstruction or Tetralogy of Fallot.

-presents suddenly, without URI prodrome

-often resolve spontaneously before ED c cold night air, shower water vapor.

Treatment

Outpt

cool mist / cool air / shower vapor

2- 4 ml Nebulized NS or

Racemic Epi 0.25-0.75ml in 2.5ml NS

4/14/06 DONALDSON (adapted from Lampe, Rosen)