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Croup Algorithm
Croup Algorithm
VIRAL LARYNGO
TRACHEOBRONCHITIS
most common:
6 months – 6 years
Coryzal symptoms
Barking cough
Leave child in a comfortable position Able to drink
Do not insert tongue depressor Generally fever <38.5°C
Do not take blood Harsh stridor
Do not X-ray No drooling
Hoarse voice
Consider Others:
Bacterial tracheitis
Epiglottitis
Assess Severity according to degree of respiratory FB Obstruction
distress Angio-oedema
Laryngomalacia
Retropharyngeal abscess
Thermal chemical injury
Severe Croup*
Moderate Croup*
Mild Croup* Agitation or lethargy
• No stridor at rest Stridor and Laboured breathing
• No significant chest chest wall Tachypnoea & recession
wall recession at rest indrawing at rest Decreased air entry
• Barking Cough Normal Altered conscious level
conscious level Severe hypoxemia is a
late sign of significant airway
obstruction
Give oral
dexamethasone 0.15
Give oral dexamethasone
mg/kg (max 12mg)
0.3 mg/kg (max 12mg)
Educate parents Any
Minimise intervention
regarding course of Deterioration
Position of comfort
illness; when to seek
Observe for improvement
medical attention
Discharge home
Give O2
Give 5ml of nebulised adrenaline
Admission 1:1000 or racaemic adrenaline 0.5ml
Admit if stridor still present at rest 4 hours after adrenaline made up to 4ml 0.9%NaCl (either can
neb or if 2 or more adrenaline nebs given be repeated)l AND up to 0.6mg/kg
Lower threshold for admission if dexamethasone (max 12mg) PO/IM/IV
Under 6 months Notify PICU/anaesthesia if not
Previous history of severe croup responding to 1st adrenaline and
Late evening presentation Any consider repeating adrenaline nebuliser
Subglottic stenosis Deterioration Admit if 2 or more adrenaline nebs
Downs Syndrome given
If typical history, only one adrenaline
Once admitted: neb given and if no stridor at rest after
Monitor respiratory rate and O2 saturation. 4 hours, you may consider discharge
Consider giving budesonide 2mg nebulised if after discussion with the ED consultant
oral dexamethasone is not feasible. if local policy