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Croup
Content 5
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Humidified air: Despite anecdotal evidence, cool mist or humidified air have not been proven to be effective in the treatment of croup.7
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Corticosteroids: A single dose of 0.6 mg/kg/dose dexamethasone (orally or intramuscularly) is now considered standard of care regardless of level of acuity of symptoms.1,3 Dexamethasone is preferred over prednisolone due to its long duration of action (48-96 hours), so repeat doses are usually not needed.
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Racemic epinephrine: Data supports its use as a bridge for short-term relief while waiting for corticosteroids to take effect. Effects last 2 to 3 hours, and patients should be monitored for several hours after that to assure that symptoms do not recur.
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Inhaled helium and oxygen mixture: Expensive and cumbersome to deliver, but a good alternative for patients in whom corticosteroids and epinephrine are ineffective or contraindicated. Repeated courses of epinephrine and heliox can help avoid intubation.
This patient's severity of symptoms would be classified as "moderate." She should receive steroids and can receive racemic epinephrine (if available) while waiting for steroids to take effect. She should be monitored for improvement of symptoms; if she does not improve, she should be admitted to the hospital for further monitoring and treatment.
Which of the following is indicated in the child with croup (laryngotracheobronchitis) presenting to the emergency department?
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The correct answer is C. You answered A.
The correct answer is "C." Corticosteroids help to decrease the glottic edema. One dose of dexamethasone 0.3 to 0.6 mg/kg (maximum of 10 mg) can be given via multiple routes (PO/IM/IV) and is usually sufficient to improve the airway swelling enough to allow the child to breathe comfortably. The advantage of dexamethasone over prednisone or another corticosteroid is that its long half-life obviates the need for further dosing at home. Antibiotics are typically not needed as the underlying etiology is a virus, such as parainfluenza virus, and not bacterial.