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)
Dexamethasone
0.3 mg/kg (max 8 mg)
Racemic Epinephrine
2.25% solution, 0.5 mL in 3 mL NS
- No or mild stridor at rest
- No or minimal WOB
- Able to tolerate PO feeding
Sustained
improvement for 2 hrs
improvement for 2 hrs
Continued or
recurrent stridor
recurrent stridor
Repeat racemic epinephrine
Consider
admission
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
- Consider:
- Repeat dexamethasone
- Repeat racemic epinephrine
- Further Evaluation
- Alternative Diagnoses
Posted: August 2023
Editors: Clinical Pathways Team
Editors: Clinical Pathways Team
Evidence
- An Update Highlighting the Effectiveness of 0.15 mg/kg of Dexamethasone
- Comparison Between Single-dose Oral Prednisolone and Oral Dexamethasone for the Treatment of Croup: A Randomized, Double-blind Clinical Trial
- A Randomized Comparison of Dexamethasone 0.15 mg/kg Versus 0.6 mg/kg for the Treatment of Moderate to Severe Croup
- Efficacy of a Small Single Dose of Oral Dexamethasone for Outpatient Croup: a Double Blind Placebo Controlled Clinical Trial
- Oral Dexamethasone in the Treatment of Croup: 0.15 mg/kg Versus 0.3 mg/kg Versus 0.6 mg/kg