Patient (condition)
 
Aliases:
Croup

Topic aliases are alternate phrasings for a particular topic.


Inflammation involving the GLOTTIS or VOCAL CORDS and the subglottic larynx. Croup is characterized by a barking cough, HOARSENESS, and persistent inspiratory STRIDOR (a high-pitched breathing sound). It occurs chiefly in infants and children.

www.nlm.nih.gov/cgi/mesh/...

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If a child with croup requires intubation, consider ongoing steroid therapy to reduce airway inflammation prior to extubation (eg IV methylprednisolone 1mg/kg bd)

Reassess for leak in 48hrs. If no leak, consider another 24 hrs of therapy prior to considering extubation.

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Management is based on severity.

Mild to Moderate - Steroids

Severe - Nebulised adrenaline plus steroids

See RCH clinical guidelines for further details

www.rch.org.au/clinicalgu...

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Supplemental oxygen if required

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If IV access is indicated consider the risk that attempting to obtain IV access may agitate the alert child and potentially worsen airway obstruction.

In this context consider reducing airway inflammation non-invasively with nebulised adrenaline and IM Dexamethasone (if indicated) first.

The obtunded child is unlikely to become agitated.

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Lessons from RCH experience
Admit to hospital any children with croup who has stridor at rest
· Beware the child with pre-existing upper airway problems who develops viral croup (rather than being reassured that their baseline is not normal and therefore it’s OK for them to have stridor)
· Don’t send children home with croup in the early hours of the morning, especially if the child has received a disease modifying agent that may or may not work (dexamethasone or adrenaline)
· If a child arrives by ambulance that should lower our threshold for hospital admission
· Three strikes and you’re in (if a child presents a third time during the same acute illness, such as croup, just admit them and sort it out from there)
· If a child needs three doses of adrenaline in the space of 1 hour, admit to PICU
· A child with croup should not be discharged from hospital until they have had one full night without needing adrenaline, and stridor at rest has resolved

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Royal Children's Hospital guideline on management of croup

www.rch.org.au/clinicalgu...

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