Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Children with Croup

Signs of Impending Respiratory Failure
  • Change in mental status
  • Severe WOB
  • Hypoxemia
Mild
Moderate/Severe
  • No or mild stridor at rest
  • Stridor only during agitation/activity
  • No or mild WOB
  • Stridor at rest
  • Moderate, severe WOB

Dexamethasone
0.3 mg/kg (max 8 mg)

Supportive Care

Dexamethasone
0.3 mg/kg (max 8 mg)

Racemic Epinephrine
2.25% solution, 0.5 mL in 3 mL NS

Supportive Care
  • No or mild stridor at rest
  • No or minimal WOB
  • Able to tolerate PO feeding
Sustained
improvement for 2 hrs
Continued or
recurrent stridor
Repeat racemic epinephrine
Consider
admission
Inpatient Management
If continued severe symptoms or impending respiratory failure, consider advanced therapeutics (e.g., heliox, PPV) and ICU admission
Sustained improvement for minimum of 8 hrs after last dose of racemic epinephrine
Inadequate Improvement
Signs of Impending Respiratory Failure
  • Change in mental status
  • Severe WOB
  • Hypoxemia
Escalate care as appropriate