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  1. Administer humidified oxygen to keep oxygen saturation >90%
  2. Treat with racemic epinephrine aerosol
    1. 0.5 ml
    2. Dilute with saline to equal 3 mL.
    3. May repeat prn Q1-2 hour.
  3. Maintenance IV fluids (see Vascular Access)
  4. If prolonged capillary refill time
    1. 20 ml/kg IV fluid bolus 0.9% NS or Lactated Ringer’s
  5. Treat fever with antipyretics
  6. IV corticosteroids
    1. Dexamethasone (Decadron) 0.6 mg/kg/dose Max dose of 10 mg
    2. Solu-Medrol 2 mg/kg max dose of 60 mg.
  7. Heliox inhalation for short-term benefits.
  8. Controlled intubation with rapid sequence induction for severe stridor with impending respiratory failure (consider back-up availability with ENT or anesthesia).
    1. Use ETT 1 size smaller than indicated by age
  9. See Intubation and Rapid Sequence Induction


  1. Brown, J.C., The management of croup. Br Med Bull, 2002. 61: p. 189-202
  2. Cherry, J.D., Clinical practice. Croup. N Engl J Med, 2008. 358(4): p. 384-91