Podcast #121 – Acute Management of Croup
Classically, patients are between 6 months and 3 years of age with a sudden onset of a barky cough, inspiratory stridor, hoarseness, and respiratory distress that is worse at night. The barking cough usually disappears after 48 hours and often lasts only 3-7 days.
A Canadian paper outlines some of the key differential diagnoses which we included as a table below along with adding the importance of recognizing retropharyngeal, parapharyngeal, and peritonsilar abscesses.
Nebulized epinephrine (usually racemic) is safe, effective, and fast acting. The effects can be within 10 minutes and disappear after 2 hours. Safe discharge can be done in 2-4 hours.
Other therapies do exist, but their evidence such as with heliox is limited. Children who fail the initial measures may require pediatric ICU admission.
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