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Croup Clinical Pathway – Emergency Department and Inpatient

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

Signs of Impending Respiratory Failure

  • Change in mental status
    • e.g., anxiety, agitation
  • Severe retractions
  • Hypoxemia
  • Escalate care as appropriate
 
 
 
 
 
 
 
 
Mild
Moderate/Severe
  • No or mild stridor at rest
  • Stridor only during agitation/activity
  • No or mild WOB
  • Significant 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 respiratory distress
  • Able to tolerate PO feeding
 
 
 
 
 
 
Continued moderate/severe signs/symptoms
 
 
Repeat racemic epinephrine
 
 
 
 
Sustained improvement for 2 hrs
Continued moderate/severe signs/symptoms
  • Repeat racemic epinephrine as needed
  • Consider Heliox, NIPPV

Signs of Impending Respiratory Failure

  • Change in mental status
    • e.g., anxiety, agitation
  • Severe retractions
  • Hypoxemia
  • Escalate care as appropriate
 
 
 
 
Admit
 
 
 
 
 
 
Sustained improvement for minimum of 8 hrs after last dose of racemic epinephrine
Inadequate Improvement
 
 

Consider

 

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