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- Administer humidified oxygen to keep oxygen saturation >90%
- Treat with racemic epinephrine aerosol
- 0.5 ml
- Dilute with saline to equal 3 mL.
- May repeat prn Q1-2 hour.
- Maintenance IV fluids (see Vascular Access)
- If prolonged capillary refill time
- 20 ml/kg IV fluid bolus 0.9% NS or Lactated Ringer’s
- Treat fever with antipyretics
- IV corticosteroids
- Dexamethasone (Decadron) 0.6 mg/kg/dose Max dose of 10 mg
- Solu-Medrol 2 mg/kg max dose of 60 mg.
- Heliox inhalation for short-term benefits.
- Controlled intubation with rapid sequence induction for severe stridor with impending respiratory failure (consider back-up availability with ENT or anesthesia).
- Use ETT 1 size smaller than indicated by age
- See Intubation and Rapid Sequence Induction
- Brown, J.C., The management of croup. Br Med Bull, 2002. 61: p. 189-202
- Cherry, J.D., Clinical practice. Croup. N Engl J Med, 2008. 358(4): p. 384-91