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
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 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
- Repeat dexamethasone
- Repeat racemic epinephrine
- Further Evaluation
- Alternative Diagnoses
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
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