CROUP
FEATURES
- Harsh barking cough
- Hoarse voice
- Stridor
- Respiratory distress
DIFFERENTIAL DIAGNOSIS
- Inhaled foreign body
- Bacterial tracheitis
- Angioedema
- Tracheomalacia
- Epiglottitis
- Retropharyngeal abscess
| Mild | Moderate | Severe | |
| Barking cough | Occasional | Frequent barking cough. | Frequent barking cough. |
| Stridor | None at rest | Easily audible stridor at rest | Prominent inspiratory (+/- expiratory) stridor at rest. |
| Recession | None / mild | Moderate | Severe |
| Distress / Agitation | None | None – slight | Significant |
| Level of consciousness | Playful/ Oral intake |
Can be placated. Interested in surroundings |
Difficult to placate or may be lethargic / restless |
SCORING
|
Stridor None 0 On crying 1 At rest 2 Severe (biphasic) 3 |
Recession None 0 On crying/exertion 1 At rest 2 Severe 3 |
Admit If:
- Stridor at rest
- CROUP score >3
TREATMENT
|
o ORAL DEXAMETHASONE 150microg/kg STAT (maximum 8 mg,) o Nebulised Budesonide 2 mg as a single dose (Repeat after 12 hours) o Nebulised Adrenaline 1:1000 (1mg/ml) 0.4 ml/kg/dose STAT, (maximum 5 ml) o CONSIDER PICU if the croup score is >5. o IV Dexamethasone must be used only after the child’s airway is made secure. |