croup management in ER

Question 1

recommended dose for children with croup and when to give

Answer 1

0.6 mg/kg dex for all children with group, regardless of if mild-severe

Question 2

when to refer to ENT for croup

Answer 2

if child has recurrent episodes, has very severe croup with poor response to EPI, or if outside typical age range of 6 months-3 years of age

Question 3

dose of epinephrine and which type to use

Answer 3

whatever is available equally effective either 0.5 mL of racemic epi in 2.5 mL NS or 5 mL 1:1000 L epi (most commonly available) same dose as above regardless of age or weight

Question 4

what is the evidence for adding inhaled budesonide?

Answer 4

no evidence it improves things

Question 5

oral vs IM vs IV vs inhaled dex

Answer 5

oral preferred, inhaled ineffective, IM possible if child can’t tolerate oral

Question 6

duration of effect of racemic epi

Answer 6

30 mins post and should last at least 1 hour, will stop working by 2 hours

Question 7

when to use racemic epi in ER and how long to observe for

Answer 7

use if severe croup (i.e. stridor at rest with sever indrawing) dont need for moderate croup observe x 4 hours, if still requiring epi post 4 hours steroids then admit

Question 8

algorithm for croup management in ER

Answer 8