E) All of the above medications and doses are acceptable
Dexamethasone 0.15 to 0.6 mg/kg orally has been shown to reduce repeat visits and improve symptoms faster for even mild croup. A few small studies support a dose of 0.15 mg/kg to not be inferior to the more widely accepted 0.6 mg/kg (typical maximum dose 10-16mg). For moderate or severe croup, the full 0.6 mg/kg may be more appropriate. Nebulized racemic epinephrine 2.25% at 0.05 mL/kg to a maximum of 0.5 mL (typically diluted in NS to a volume of 3mL) is indicated for patients with moderate to severe croup, especially if there is stridor at rest. L-epinephrine can be used instead of racemic epinephrine, however, at 0.5 mL/kg to a maximum of 0.5 mL. If nebulized epinephrine was given for significant stridor and the patient improves, the patient should be observed for 2-3 hours to ensure that stridor doesn’t return.
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December 18, 2018 at 9:51 am
E) All of the above medications and doses are acceptable
Dexamethasone 0.15 to 0.6 mg/kg orally has been shown to reduce repeat visits and improve symptoms faster for even mild croup. A few small studies support a dose of 0.15 mg/kg to not be inferior to the more widely accepted 0.6 mg/kg (typical maximum dose 10-16mg). For moderate or severe croup, the full 0.6 mg/kg may be more appropriate. Nebulized racemic epinephrine 2.25% at 0.05 mL/kg to a maximum of 0.5 mL (typically diluted in NS to a volume of 3mL) is indicated for patients with moderate to severe croup, especially if there is stridor at rest. L-epinephrine can be used instead of racemic epinephrine, however, at 0.5 mL/kg to a maximum of 0.5 mL. If nebulized epinephrine was given for significant stridor and the patient improves, the patient should be observed for 2-3 hours to ensure that stridor doesn’t return.