ED - Croup - Laryngotracheitis (6 mo - 6 years)
Last Updated: 12/5/2015 9:36:20 AM
Order Set
  Associated Pathway(s)
 Croup - Laryngotracheitis (6 mo - 6 years) - http://www.curbsideup.com/link/20
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  Inclusion Criteria
Inclusion Criteria ( Any one criteria present )
  • Clinical symptoms consistent with croup
Exclusion Criteria
  • Toxic appearance
  • History of upper airway anatomical or functional abnormality
  • Hypotonia or neuromuscular disorder
  GENERAL
  Monitoring
Vitals per protocol
Weight
ONCE
  Does this patient need to be NPO?
Yes
Diet NPO
Continuous
No
PO Challenge
Diet Regular
MD to RN communication
Make patient NPO for respiratory distress, mental status changes or expectation of pending surgical or other procedure requiring sedation
  Does this patient require isolation?
      All patients with history of MRSA or VRE should receive Contact Isolation order.
Yes
Contact Isolation
(eg. MRSA, VRE, etc.)
Contact/Droplet Isolation
(eg. RSV, Rhinovirus, etc.)
Contact Plus
(eg. C. difficile, Norovirus)
Airborne Isolation
(eg. TB, VZV, Measles, etc.)
  Respiratory Therapy
  Respiratory Care
MD to RN communication
Begin supplemental oxygen therapy for persistent oxygen saturation below 90% awake, 88% asleep or severe respiratory distress.
Pulse Oximetry/O2 Sats
STAT, CONTINUOUS, Indication: When patient is on supplemental oxygen
Suction
As needed
  IV FLUIDS
  IV Fluids
      Maintenance: 4 ml/kg/hr for the first 10 kg, then additional 2 ml/kg/hr for the second 10 kg, then additional 1 ml/kg/hr for each kg > 20 kg.
Saline Lock and Flush
NS IV bolus
20 ml/kg, Intravenous, Once
D5-NS IV infusion
Intravenous, CONTINUOUS
D5-NS + KCL 20 mEq/L IV infusion
Intravenous, CONTINUOUS
D5-1/2 NS IV infusion
Intravenous, CONTINUOUS
D5-1/2 NS + KCL 20 mEq/L IV infusion
Intravenous, CONTINUOUS
  MEDICATIONS
  Glucocorticoids
      All patients with croup should receive systemic or nebulized glucocorticoids. Repeat doses of dexamethasone within 3 days has not shown improved outcomes.
Dexamethasone (DECADRON) IV - Given orally
0.6 mg/kg Oral, ONCE, Max: 10 mg, Route: OK to give IV formulation orally.
Dexamethasone (DECADRON) IV
0.6 mg/kg IV/IM, ONCE, Max: 10 mg
  Does the patient have stridor at rest AND one other clinical factor signalling significant disease?
      Sternal wall retractions, tachypnea, agitation / restlessness / lethargy, difficulty with talking or feeding
Yes
Racemic epinephrine 2.25% inhalation solution (0.5 mL nebulized) diluted in 3 mL NS
ONCE, Nebulized
  Pain Control
lidocaine (ELA-MAX, LMX) 4% cream
Topical, ONCE, Apply small amount to skin, PRN painful procedure, Note: takes 30 min to reach peak effect
lidocaine-tetracaine (SYNERA) patch 1 Patch
Transdermal, ONCE, for 30 min, PRN, painful procedure, Note: takes 20 min to reach peak effect
  Does patient have any contraindications to ibuprofen?
      Greater than 6 months, allergy or hypersensitivity, G6PD, renal impairment, severe hypovolemia, bleeding or coagulation disorder, gastritis or PUD, long bone fracture
No
Ibuprofen (MOTRIN) oral solution 10 mg/kg (Dosing Weight)
10 mg/kg, Oral, EVERY 6 HOURS, PRN, Pain mild, Temp > 38.5 C
Ibuprofen (MOTRIN) tablet 200 mg
600 mg, Oral, EVERY 6 HOURS, PRN, Pain mild, Temp > 38.5 C
  Does patient have any contraindications to acetaminophen?
      Allergy or hypersensitivity, hepatic impairment, severe hypovolemia, PKU or other liver disease, chronic malnutrition
No
Acetaminophen (TYLENOL) oral solution 15 mg/kg (Dosing Weight)
15 mg/kg, Oral, EVERY 4 HOURS PRN, Pain mild, Temp > 38.5 C
Acetaminophen (TYLENOL) tablet 650 mg
650 mg, Oral, Every 4 HOURS PRN, Pain mild, Temp > 38.5 C
Acetaminophen (TYLENOL) suppository
20 mg/kg, Rectal, Every 4 HOURS PRN, Pain mild, Temp > 38.5 C
  Does patient have any contraindications to ondansteron?
      Allergy or hypersensitivity, long QT disorders
No
Ondansteron (Zofran) 0.15 PEDIATRIC IV infusion
0.15 mg/kg IV, EVERY 8 HOURS, PRN, nausea, vomiting
Ondansteron (Zofran ODT) ODT 4mg
2 mg PO, EVERY 8 HOURS, PRN, nausea, vomiting
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