clinical practice guidelines: respiratory/croup · queensland ambulance service 158 croup croup is...
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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
158QUEENSLAND AMBULANCE SERVICE
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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159QUEENSLAND AMBULANCE SERVICE
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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