A 2-year-old child with fever and barking cough for last 2 days presented to the pediatric emergency at 2.30 am. On examination, respiratory rate is 36/ min, temperature of 39 degC and stridor heard only on crying. No other abnormality is found. What is the next best step in management?
(A) High-dose dexamethasone (B) Racemic epinephrine nebulization (C) Reassurance (D) Intravenous antibiotics
(A) Ans: A. High-dose dexamethasone(Ref Ghai 8/e p376, 398: Nelson 20/e p2032-2034)Diagnostic of laryngotracheobronchitis or croup of mild severity.Hence, high-dose dexamethasone will be the treatment of choice.Treatment:Cornerstone of Treatment: Glucocoicoids & nebulized epinephrinedegGlucocoicoids:Useful in mild, moderate & severe croup.Dexamethasone is most effective coicosteroid. Nebulized epinephrine:Useful in moderate to severe distress.By adrenergic stimulation causes,Constriction of precapillary aerioles.Decreases capillary hydrostatic pressure leading to fluid resorption from interstitium.Improvement in laryngeal mucosal edema.Antibiotics are not indicatedHeliox (mixture of oxygen & helium) has low viscosity & low specific gravity.Allows for greater laminar airflow through respiratory tract.Considered in treatment of children with severe croup.