Croup
Croup
aka laryngotracheobronchitis
DDx
Stridor / upper airway obstruction
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Symptoms / Signs
Mild
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Rx
(nb lower threshold for admission: severe, Hx severe, structural anomaly, representation, social concerns including time/transport to hospital)
Mild (no stridor at rest, tolerating fluids)
NETS (1300 36 2500)
(Summarises NSW Croup CPG)
aka laryngotracheobronchitis
DDx
Stridor / upper airway obstruction
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Symptoms / Signs
Mild
- hoarse voice
- barking cough
- intermittent inspiratory stridor
- inspiratory stridor at rest
- Some WOB
- Marked WOB
- Apathetic / restless
- Pulsus paradoxus
- Hypoxia
- reduced LOC
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Rx
(nb lower threshold for admission: severe, Hx severe, structural anomaly, representation, social concerns including time/transport to hospital)
Mild (no stridor at rest, tolerating fluids)
- DC letter
- Fact sheet
- 6m-36mo
- More common in autumn and winter
- Paraflu 1 / 2, RSV
- Preceeded by coryza, worse first night or two, can last a week
- Early steroids have reduced the need for adrenaline and intubation
- PO Dexamethasone 0.3mg/kg (less representations than prednisolone but not available in community)
- Or Prednisolone 1mg/kg PO (if dex not available)
- Or Neb Budesonide 2mg undiluted (if PO not tolerated, onset 30m v 1h for PO Rx. ? use while waiting PO in/effect)
- Monitor for 4 hours until mild
- Repeat Steroid next
- 100% O2
- Neb Adrenaline 0.5ml/kg to 5mls of 1:1000 undiluted in nebuliser (peak action 30m-2h)
- NB airway before circulation but relative contraindication in ventricular outflow tract obstruction (eg TOF)
- (?neb budesonide after adrenaline if sitting on fence waiting to see if 2nd adrenaline and tolerated (while waiting to PO effect)
- q60min clinical review for 4 hours until mild ie no stridor at rest
- PRN Neb adrenaline and top-up Dex to 0.6mg/kg (or Pred to 2mg/kg)
- 2nd dose of adrenaline > admit, q12h 0.3mg/kg dex (or 1mg/kg Pred)
- 3rd ?NETS
- Code blue
- Inhalational Intubation (Anaesthetics / ENT)
- ?Heliox (no proven benefit over adrenaline)
NETS (1300 36 2500)
(Summarises NSW Croup CPG)