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?


Continue to Monitor

  • Reassess for signs of respiratory failure

Respiratory Failure


  • 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
  • Continue to monitor
  • Reassess oxygenation and ventilation

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