A2 year old child is brought to emergency at 3 AM with fever, barking cough and stridor only while crying. The child was able to drink normally. On examination respirator rate is 36/min and temprature is 39.6degC. What will be your next step ?
Ans. is b' i.e., High dose dexamethasone injection Fever, barking cough and stridor on crying in a 2 year old child suggest the diagnosis of croup. Management of Croup The main treatment for children with croup is airway management. o Treatment of respiratory distress should take priority over any testing. o Following treatment is indicated ? 1) Humidified oxygen 2) Hydration with fluids 3) Coicosteroids Are benificial in, even in mild croup. They decrease the edema in the laryngeal mucosa through their anti-inflammatory action. They reduce the need of subsequent epinephrine use. Coicosteroids used are -4 oral dexamethasone (preferred), im dexamethasone or nebulized budesonide. 4) Nebulized epinephrine Mechanism of action is believed to be constriction of precapillary aerioles through [3-receptors, causing fluid resorption from the interstitial space and a decrease in laryngeal edema. Indication for nebulized stridor are - i) Moderate to severe stridor at rest iii) Respiratory distress ii) The possible need for intubation iv) Hypoxia 5) Heliox (80% helium and 20% 02) ---> May be effective in children with severe croup who may need intubation. 6) Antibiotics are not indicated Sedatives should not be given
Racemic epinephrine nebulization
High dose dexamethasone injection
Nasal wash for influenza or RSV
Antibiotics and blood culture