Inpatient Pathway for the Evaluation/Treatment
of the Child with Croup
of the Child with Croup
-
SIGNS OF IMPENDING
RESPIRATORY FAILURE: - Change in mental status
- Severe retractions
- Hypoxia
- Poor response to racemic epinephrine
- Call CAT team
Review ED Care, History and Physical
Observe and Assess PE, VS q 1 hour x 2
Observe and Assess PE, VS q 1 hour x 2
MILD/MODERATE SYMPTOMS
MODERATE/SEVERE SYMPTOMS
- Any of the following:
- Barky cough, hoarse voice
- No stridor at rest
- Mild coarse stridor
- Stridor only during agitation/activity
- No or mild WOB
Observe Minimum of 8 Hours
- Any of the following:
- Anxiety, restlessness
- Stridor at rest
- Moderate, severe WOB
- Hypoxemia
Racemic Epinephrine
Assess immediate response
MINOR IMPROVEMENT
NOT IMPROVED/WORSENING
- Reassess PE, VS q 1 hour x 2
- Alternate RN/RT
- Additional racemic epinephrine as needed
- Persistent symptoms > 24 hours
- Consider repeat dexamethasone
- Call MD to bedside
- Consider:
- Repeat racemic epinephrine
- Alternative diagnoses
- ICU consult/CAT call
Improved
- No stridor or mild stridor
- No or minimal respiratory distress
- Minimal retractions
- Able to tolerate PO feeding
- TREATMENT CONSIDERATIONS
- Dexamethasone
- 0.3 mg/kg, MAX 8 mg
- Racemic Epinephrine
- 2.25% solution
- 0.5 mL in 3 mL NS
- CONSIDER ALTERNATIVE DIAGNOSES
- Age < 6 months, or > 6 years
- Poor response to treatment
- Duration of stridor > 4 days or cough > 10 days
- Non-elective intubation in past 6 months
- Prolonged intubation
- Recurrent croup
- 2nd episode within 30 days
- > 3 episodes in the last 12 months
- Toxic appearance
- Drooling, difficulty swallowing, severe anxiety
- Asymmetry of the respiratory exam
- FURTHER DIAGNOSTIC TESTING
Posted: September 2014
Reviewed: January 2017, December 2018
Authors: J. Piccione, MD; M. Mittal, MD; J. Seiden, MD; B. Jenssen MD; M. Dunn MD; R. Hughes PharmD; K. Cohn MD; E. Hysinger MD; A. Buzi MD; E. Walker RT; M.F. Duff RT; J.M Malpass RT;
Reviewed: January 2017, December 2018
Authors: J. Piccione, MD; M. Mittal, MD; J. Seiden, MD; B. Jenssen MD; M. Dunn MD; R. Hughes PharmD; K. Cohn MD; E. Hysinger MD; A. Buzi MD; E. Walker RT; M.F. Duff RT; J.M Malpass RT;