dr Rachna Sharma
Pediatric Intensivist
Centre for Child Health, BLK Super Speciality Hospital
About Author

                                                       CROUP SCORE

 

Clinical Feature

Degree

Score

Stridor

None

0

On crying or agitation

1

At rest without auscultation

2

Recessions

None

0

Mild

1

Moderate

2

Severe

3

Cyanosis

None

0

With agitation

4

At rest

5

Consciousness level

Normal

0

Altered

5

 

 

 

CROUP SCORE

0-2 = Mild Croup

3-5 = Moderate Croup

6-11 = Severe croup

 

Treatment :

  1. Mild and moderate croup
    1. They can be treated as out patient
    2. Mist Therapy(Saline Nebulisations) can be given, Steam use should be discouraged because of risk of burns.
    3. Single dose of Oral Dexamethasone (0.6mg/kg- Max 16 mg) / Prednisolone (1mg/kg). In case Prednisolone is used, it may be continued for 3 days (2mg/k/day in divided doses).
    4. Explain to review again in case of danger signs*

 

  1. Severe croup
    1. Needs Hospitalisation
    2. Humidified Oxygen
    3. Oral or IM or IV Dexamethasone (0.6mg/kg, Max 16 mg)**
    4. Nebulisation with Adrenaline 1:1000, (0.5ml/kg, Add saline if total volume in nebuliser chamber is less then 3 ml, Max dose of adrenaline is 5 ml)
    5. IV fluids if oral intake poor

 

General Principles

  • Antibiotics are of no help
  • Antiallergics should not be given- They make the secretions viscid and do more harm than good
  • Child should be kept well hydrated all the times

 

*Danger signs – to be explained to parents

  • Makes a noisy, high-pitched breathing sound (doctors call it “stridor”) when child breathes in or out
  • Starts drooling or has a hard time swallowing
  • Is anxious, agitated, or has no energy
  • Breathes much faster than usual
  • Has a hard time breathing (chest muscles pull in, पसली चलना)
  • Turns gray or blue around her nose, mouth, or fingernails
  • Seems to be dehydrated, with dry lips or tongue, and/or no urine output

**Dexamethasone can be given IM, IV, or orally and should generally be administered via the least invasive route possible.

**The oral liquid preparation of dexamethasone (1 mg per mL) has a foul taste. The IV preparation is more concentrated (4 mg per mL) and can be given orally mixed with syrup



Posted On: 22/10/2019

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