Barking c ough with STRIDOR ; A harsh s ound

CROUP usually he ard during inspiration indica tiv e of upper

airw ay obstruction

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

Discharge once no No improvement

stridor at rest by 4hrs

 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