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
Respiratory Failure?
- Increased, decreased or no respiratory effort
- Poor to absent distal air movement
- Changes in level of consciousness
- Tachycardia and tachypnea are early signs
Apnea and bradycardia are late signs
Yes
Give Dexamethasone
Give PO dexamethasone (weight *0.6)mg PO/IM unless:
- Child spits out the medication
- Unable to tolerate PO
- Impending respiratory failure
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
Monitor and Transport
- Rapidly transport
- Continue to monitor
- Further orders via on-line physician