croup

Question 1

croup - most common causative pathogen

Answer 1

parainfluenza virus

Question 2

croup - how to determine if its severe (6)

Answer 2

SADTaCS
Stridor at rest
agitation
drowsiness
tachypnea
chest wall retraction
Saturation drop (acute life threat)

Question 3

croup - management (mild to moderate)

Answer 3

minimal handling of child
allow child to pick a position they are comfortable in
all croup benefits from steroids ( any of these regimens valid )
- prednisolone 1mg/kg PO up to 50mg, repeat dose following evening.
- dexamethasone 0.15mg/kg PO stat
- budesonide 2mg neb (if oral not tolerated)

Question 4

croup - when should they be admitted (8)

Answer 4

no improvement after initial treatment

• 30mins post oral steroids
• requiring repeated doses of nebulised adrenaline
• Stridor at rest 4hrs post nebulised adrenaline

admission history

• 2nd presentation with stridor in same illness
• previous admissions for severe croup

anatomical

• down syndrome
• pre-existing narrowing of upper airway

social circumstances
- presents overnight, lives far from medical care

Question 5

Croup - ddx (4)

Answer 5

inhaled foreign body
bacterial tracheitis
anaphylaxis
retropharyngeal/peritonsillar abscess

Question 6

croup - management (severe)

Answer 6

minimal handling of child
allow child to pick a position they are comfortable in
nebulised adrenaline, 0.5mL/kg of 1:1000, max 5mL)
+
dexamethasone 0.6mg/kg, max 12mg, IM/IV/PO

Question 7

croup - dexamethasone dosage regimen in

• mild/moderate
• severe

Answer 7

mild-moderate - 0.15mg/kg stat dose. PO

severe - 0.6mg/kg up to 12mg stat, IM/IV/PO

Question 8

croup - budesonide dosage regimen

Answer 8

2mg via nebuliser