Clinical Practice Guidelines: Respiratory/Croup

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Date April, 2016

Purpose To ensure consistent management of patients with Croup.

Scope Applies to all QAS clinical staff.

Author Clinical Quality & Patient Safety Unit, QAS

Review date April, 2018

URL https://ambulance.qld.gov.au/clinical.html

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Croup

Croup is a viral illness (most often parainfluenza) that causes variable airway obstruction due to inflammatory oedema of

the subglottis.

Clinical features

• Coroyzal prodrome (URTI), hoarse/husky

voice, inspiratory stridor, harsh ‘barking seal like’ cough. May have widespread

wheeze, increased work of breathing and fever.[1]

• Generally affects children 6 months–3 years.[2]

• Duration of 2–5 days, symptoms worse at night.

• Assess child for severity of illness to help guide therapy (see table opposite)

• Loudness of stridor is NOT a good guide to the severity of the obstruction.

• ALOC, hypotonia, cyanosis and pallor are all signs of life-threatening airway obstruction.

Mild Moderate Severe

Behaviour Normal Irritable Increasing irritability and/or lethargy

Stridor Barking cough, stridor when active/upset

Stridor +/- at rest

Stridor at rest

Respiratory rate

Normal Increased, tracheal tug, nasal flare

Marked increase/decrease, tracheal tug, nasal flaring

Accessory muscle use

None/minimal Moderate Marked

Oxygen saturations

Normal Normal Hypoxaemia is a late sign

NOTE:  Do not perform examinations that create anxiety (do not examine the throat or take child away from parent)

April, 2016

Figure 2.49

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Additional information

• ALL patients should be transported to hospital for assessment, irrespective of clinical condition

after initial management.

• Nebulised adrenaline (epinephrine) is a

temporising measure only, symptoms may return.

• ETI will be extremely difficult due to inflammation

and oedema of the airway.

• In all children consider alternate diagnosis:

- Inhaled foreign body

- Epiglottitis

- Bacterial tracheitis

• Humidified air has not been shown to change the severity of the illness

• Antitussives have no role in croup and may

increase sedation and therefore alter the

assessment.

e

Note: Officers are only to perform procedures for which they have received specific training and authorisation by the QAS.

Stridor at rest?

Consider:

• Oxygen

Risk assessment

• Pre-existing narrowing of upper airways

(subglottic stenosis or Down syndrome)

• Previous admission with severe croup

Y N

CPG: Paramedic Safety

CPG: Standard Cares

Consider:

• Calm patient

• Allow patient to assume positionof comfort

• Oxygen

• Adrenaline Neb

Transport to hospital

Pre-notify as appropriate

Oxygen

Oxygen

Adrenaline Neb

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