View source for Infectious Upper Airway Obstruction - Croup or Epiglottitis

==Section 3 - RESPIRATORY==
===3.04 INFECTIOUS UPPER AIRWAY OBSTRUCTION CROUP/EPIGLOTTITIS===

====Croup====
* Sudden onset dyspnea, barking cough, stridor in a previously well - afebrile child
* Stridor at night 1 AM – 5 AM
* Hoarse voice
* Fever is common
* Chest usually clear – may have mild wheezing
* Stridor may be both inspiratory and expiratory
* Intercostals retractions and nasal flaring may be present
* Severe lethargy and agitation
* Tachycardia and tachypnea
* Cyanosis is late and ominous sign


====Viral-Bronchiolitis====
* Wheezing in infants caused by infectious agents (i.e. Flu, RSV, CMV and others)


====TREATMENT====
[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)Administer humidified [[Oxygen|OXYGEN]] @ 100% via Pediatric mask or ‘blow-by’ technique. Significant attempts should be made to keep child calm at all times;
including allowing parents close contact with patient during transport.
* Do not attempt aggressive airway intervention unless airway becomes obstructed.
* Initiate IV access ONLY after airway control is established and patient’s condition warrants this intervention.
*Obtain history and assess respiratory status.
* If wheezing present, [[Albuterol|ALBUTEROL (PROVENTIL)]], refer to Handtevy System. Monitor heart rate. ([[Atrovent|IPRATROPIUM BROMIDE (ATROVENT)]] is not indicated).
* For wheezing with viral illness or spasmodic croup not responding to [[Albuterol|ALBUTEROL]].
**Pulse oximetry
**O2 and [[Racemic Epinephrine|RACEMIC EPINEPHRINE (VAPONEFRINE)]] via blow-by updraft, refer to Handtevy
**0.5 ml [[Racemic Epinephrine|RACEMIC EPINEPHRINE (VAPONEFRINE)]] in 2 ml Saline, nebulized
**Requires 4-6 hrs observation in the ER

'''NOTE: RACEMIC EPINEPHRINE is not the treatment of choice for Epiglotitis and should be
limited to patients without stridor, who have a barking cough and are tachypneic.'''

*If the patient is not responding to the above interventions, administer [[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]], refer to Handtevy System.
* If breathing becomes labored, assist ventilations with [[Oxygen|OXYGEN]] @ 100% via BVM
* If patient becomes apneic, perform endotracheal intubation.
* If unable to ventilate and airway not patent, perform [[Cricothyrotomy Surgical|Cricothyrotomy]], (use [[Cricothyrotomy Needle|Needle Cricothyrotomy]] technique in children under age 12).


'''''In the event of impending acute Airway Obstruction and Cardiac Arrest, [[Epinephrine|EPINEPHRINE]] may be administered IV or IM as per Handtevy System.'''''

[[Category:Respiratory|0304]]