Croup Diagnosis and Management Pearls
Common childhood illness, usually viral and self limiting. Characterised by a seal-like "barking" cough.
Accompanied by respiratory distress, stridor (due to subglottic narrowing), hoarse voice +/- fever. Often an URTI like prodrome (non-specific cough, rhinorrhea, and fever). Commonly affects children between 6 months and 6 years (peak age 2).
Symptoms are usually worse at night. Symptoms usually resolve within 48 hours. Symptoms of impending respiratory failure include increasing upper airway obstruction, fatigue, sternal/intercostal recession, see-saw breathing, pallor or cyanosis, decreased level of consciousness.
Evaluation:
 • Mild croup: Seal-like barking cough. No stridor or recession at rest. This can usually be managed at home  → Patient advice leaflet.
 • Moderate croup: Seal-like barking cough with stridor and recession at rest. No agitation or lethargy.
 • Severe croup: Seal-like barking cough with stridor and recession associated with agitation or lethargy.
BEWARE: The degree of chest wall recession may diminish as the child tires!
Treatment: Single dose of oral dexamethasone - 0.15 mg/kg body weight

PeterboroughEM @PeterboroughEM

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