ENT
CROUP
PromptInitial management of croup
ResponseNebulised adrenaline - 5mg (0.5mg/kg)
Steroids - dexamethasone 0.6mg/kg (IV/IM/PO)
Observation
Parental reassurance
Steroids - dexamethasone 0.6mg/kg (IV/IM/PO)
Observation
Parental reassurance
PromptIndications for intubation in croup
ResponseExhaustion from increased WOB
Hypercapnic respiratory failure (type 2 respiratory failure)
Hypoxaemic respiratory failure (type 1)
Decreased level of consciousness and unable to protect airway
Imminent complete airway obstruction
Hypercapnic respiratory failure (type 2 respiratory failure)
Hypoxaemic respiratory failure (type 1)
Decreased level of consciousness and unable to protect airway
Imminent complete airway obstruction
PromptIndicators of impending respiratory arrest in croup
ResponseHypoxia
Marked decreased respiratory rate
Decreased conscious state
Marked decreased respiratory rate
Decreased conscious state
PromptInterventions whilst preparing for intubation in severe croup
ResponseKeep patient calm and upright for as long as possible
Optimise medical management - adrenaline neb 5mg, dexamethasone 0.3mg/kg PO/IV
HF oxygen (2L/kg) via NP
IV access (can delay til last minute)
Explanation to the parent
Optimise medical management - adrenaline neb 5mg, dexamethasone 0.3mg/kg PO/IV
HF oxygen (2L/kg) via NP
IV access (can delay til last minute)
Explanation to the parent
PromptEquipment for intubation in severe croup
ResponseBVM with size (250 mL - newborn, 500 mL - neonates, 1500mL - infants to adults - rch)
Laryngoscope with miller blades (size 2) and Macintosh blade (size 2)
ETT + one size smaller due anticipated laryngeal oedema(List size based on age in question)
Bougie
Suction
LMA + size
Surgical airway equipment/needle cricothyroidotomy
Ketamine 2mg/kg
Rocuronium 1.2mg/kg (or sux 1-2 mg/kg)
Laryngoscope with miller blades (size 2) and Macintosh blade (size 2)
ETT + one size smaller due anticipated laryngeal oedema(List size based on age in question)
Bougie
Suction
LMA + size
Surgical airway equipment/needle cricothyroidotomy
Ketamine 2mg/kg
Rocuronium 1.2mg/kg (or sux 1-2 mg/kg)
PromptAlterations from standard RSI in severe croup
ResponsePreoxygenation and induction in seated position - avoid further distress/airway obstruction
Bag through apnoeic period - prevent hypoxia
Smaller size ETT - predict airway oedema
Avoid paralysis - Tone keeps cords open, paralysis >> loss of tone >> Dead kid
Videolaryngoscopy - maximise view
Bag through apnoeic period - prevent hypoxia
Smaller size ETT - predict airway oedema
Avoid paralysis - Tone keeps cords open, paralysis >> loss of tone >> Dead kid
Videolaryngoscopy - maximise view