Croup

HISTORY:

‍Respiratory distressStridorBarking cough for ‍ ‍hoursdays

Onset: ‍gradualsudden, following ‍ ‍sleeping

Severity: ‍mildmoderatesevere

Treatments tried: ‍nonecold air, ‍effectiveineffective

‍stridor

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍shortness of breath

‍wheezing

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍rhinorrhea, ‍clearcolored

‍nasal congestion

‍sore throat

‍fatigue

‍decreased fuild intake

‍decreased appetite



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: fontanelles ‍soft, ‍normocephalic

Eyes: -R: ‍normal, -L: ‍normal, ‍

Ears: -R: ‍normal, -L: ‍normal

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normalrednessexudate

Mouth: ‍normal

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍normal, ‍normal pulses, cap refill ‍< 3 sec> 3 sec

Skin: ‍no rash

Mental status: ‍alert, ‍, reactive to ‍



ASSESSMENT:

‍Viral croup ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Chest X-ray

- Blood gas

- Put child on parent's lap in upright position

- Humidified oxygen

- ‍Dexamethasone

- ‍Nebulized epinephrine if resting stridor or significant retractions

- Observe for 3 hours and until resting stridor and retractions resolve

- Hospitalization if no improvement after 3 rounds of epinephrine

- Cold and humidified air (e.g. bathroom with cold shower running)

- Saline nasal irrigation

- Encourage oral hydration

- Go to ER if severe shortness of breath, signs of dehydration, or high fever

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or persist after 3 days