Croup Management

The old-fashioned-sounding illness is mostly harmless. So why does it cause so much parental panic - Daniel Engber

Croup Management
Croup Management

image by: Philippe Put

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Briefs: All bark and no stridor

In many ways the management of sicker patients with suspected croup is more straightforward. Give them steroids early, let the patient protect their own airway and use inhaled racemic epinephrine. But what about the larger majority of kids that you might see in the ED (usually between 10PM and 4AM) who now have a barky cough and that’s it. Sure, maybe they had stridor at home, but not in the ED with you, where they are as happy as a clam watching Jake and the Neverland Pirates.

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 Briefs: All bark and no stridor

Goal #1 is to identify kids with complete or partial upper airway obstruction. If a child in distress with stridor is moving air, and is at least somewhat comfortable LEAVE THEM BE (Preferably in the arms of a caregiver). A scared child will get tachypneic, which causes increased negative intrathoracic pressure which leads to further narrowing of the subglottic airway upon inspiration.

5 Essential Steps to Managing Croup

Standard L-Epinephrine (1:1000) up to 5 mg nebulized, has been shown to be just as safe as, and possibly more effective than racemic epinephrine.

Life in the Fastlane

CLINICAL FEATURES autumn & early spring 6 months -> 2 years URTI -> barking cough, hoarseness, stridor secretions +++ mild fever dysphagia.

Pediatric EM Morsels

Admit: Stridor at rest despite racemic Epi, Persistent respiratory distress, Dehydration, Poor social situation.

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