Croup

Patient Care Goals

Promptly identify pediatric respiratory distress, failure, and/or arrest, and intervene for patients who require escalation of therapy.

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes. 
□ Focus on rapid and early BLS airway and ventilation tools. Intubation may not be the best option for these patients. 
□ Identify signs of severe respiratory distress 		□ Upper respiratory illness 
□ Barky cough
□ Fever
□ Inspiratory or Expiratory Stridor 		□ Asthma
□ Foreign body aspiration
□ Bronchiolitis
□  Epiglottitis
□ Croup
□ Pertussis
□ Submersion/Drowning

Clinical Management Options

EMT-B
• Place in position of comfort
• Oxygen target SpO2 92% – 96%  
• Suction the nose and/or mouth (via wall mount or portable suction)
• Basic airway management as needed
• Consider ALS intercept for any evidence of worsening or severe respiratory distress
Paramedic
• Monitor ETCO2 if the patient tolerates it
• Consider IV for signs of hypovolemia
• Provide Dexamethasone
• Provide Inhaled Epinephrine for severe respiratory distress that is not improved with suctioning and/or oxygen 
• Cardiac Arrest Epinephrine: Nebulize 5 mL of 0.1 mg/mL (0.5 mg) 
• Intramuscular Epinephrine: concentration: 1:1,000 dose: 0.15mg (0.30mg if >25kg)
• NIPPV for severe respiratory distress 
Signs of Respiratory Failure-Separate checklist under pearls please
• Change in mental status such as fatigue and listlessness 
• Pallor 
• Dusky appearance 
• Decreased retractions 
• Decreased or irregular respiratory rate

Consult Online Medical Control as Needed

Pearls

  • Refer to drug formulary charts for all medication dosing for both adults and pediatric patients. 
  • Upper airway obstruction can have inspiratory, expiratory, or biphasic stridor.  
  • Foreign bodies can mimic croup, it is important to ask about a choking event.  
  • Impending respiratory failure is indicated by: 
    • Change in mental status such as fatigue and listlessness.  
    • Pallor  
    • Dusky appearance  
    • Decreased retractions  
    • Decreased breath sounds with decreasing stridor.  
  • Without stridor at rest or other evidence of respiratory distress, inhaled medications may not be necessary.