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Question: Resp

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You are seeing a toddler with 2 days of cough, congestion, and low-grade fever, who now presents with a worsened barky cough. His vital signs in the ED are temp 38.3 C, HR 110, RR 26, BP 80/40, O2 sat 96% on room air. He has stridor when crying but none at rest. He has no history concerning for foreign body aspiration. He is not happy to be in the ED but is not toxic appearing. He is fully immunized and has no significant past medical history. 

Which of the following is the most appropriate next step?

pemsou5_wp • October 19, 2021

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  1. Kelly October 21, 2021 - 5:56 pm Reply

    D) Administer dexamethasone 0.3 mg/kg orally. The patient has a classic case of viral croup. Although bacterial tracheitis, epiglottitis, and foreign body aspiration are in the differential diagnosis, the scenario does not support these diagnoses. Routine radiographs are not indicated unless an alternate diagnosis is strongly suspected and can be supported by radiographic signs. Cool mist therapy, although frequently used with viral croup, has not been shown to improve outcomes. Dexamethasone, however, orally or parenterally, has been shown to improve outcomes and decrease need for admission for all severity levels of croup. Although the classic dose is 0.6 mg/kg, subsequent studies have shown lower doses to be as effective. Racemic epinephrine is typically used for more severely affected patients with stridor at rest. If it resolves the stridor, the patient should be observed for 2-3 hours prior to discharge, to make sure symptoms do not rebound as the effects of the racemic epinephrine wear off.

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