The UMC Emergency Medicine Podcast

Croup

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Episode Summary: Croup Management

  • Management of croup depends on the severity of illness.
  • Dexamethasone is recommended for all severities.
    • Dose: 0.15–0.6 mg/kg PO (maximum 16 mg).
  • Nebulized epinephrine is indicated for moderate to severe croup.
    • Commercial racemic epinephrine: 0.5 mL of 2.25% solution.
    • If racemic epinephrine is unavailable, nebulized L-epinephrine (1 mg/mL) can be prepared:
      • 0.5 mL/kg per dose, diluted with 0.9% sodium chloride to a total volume of 4–5 mL.
      • Do not exceed 5 mL total volume.
      • In severe cases, consider IM epinephrine:
        • 0.01 mg/kg (0.01 mL/kg of the 1 mg/mL concentration)
        • Maximum single dose: 0.3 mg
        • Severity classification can be guided by a scoring system.
          • The most commonly used tool is the Westley croup score: https://www.uptodate.com/contents/calculator-westley-croup-severity-score-appropriate-for-use-in-children-6-years-of-age
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          The UMC Emergency Medicine PodcastBy InnaKaminecki