Croup

Objectives

1. In patients with croup,
   • Identify the need for respiratory assistance (e.g., assess ABCs, fatigue, somnolence, paradoxical breathing, indrawing)
   • Provide that assistance when indicated. Clinical Reasoning Selectivity Treatment
2. Before attributing stridor to croup, consider other possible causes (e.g., anaphylaxis, foreign body (airway or esophagus), retropharyngeal abscess, epiglottitis).
3. In any patient presenting with respiratory symptoms, look specifically for the signs and symptoms that differentiate upper from lower respiratory disease (e.g., stridor vs. wheeze vs. whoop).
4. In a child presenting with a clear history and physical examination compatible with mild to moderate croup, make the clinical diagnosis without further testing (e.g., do not routinely X-ray).
5. In patients with a diagnosis of croup, use steroids (do not under treat mild-to-moderate cases of croup).
6. In a patient presenting with croup, address parental concerns (e.g., not minimizing the symptoms and their impact on the parents), acknowledging fluctuating course of the disease, providing a plan anticipating recurrence of the symptoms.