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Immediate risk stratification
Severity and stabilization priorities
Toxic appearance
Altered mental status
Exhaustion
Poor air entry
Airway and breathing red flags
Stridor at rest
Severe retractions
Cyanosis
Apnea
High-risk contexts
Age < 6 months
Known airway anomaly
Prior intubation for croup
Monitoring and environment
Monitoring and setup
Continuous pulse oximetry for moderate to severe disease
SpO2 trend over spot checks
Cardiorespiratory monitoring when nebulized epinephrine used
Tachyarrhythmia risk
Minimal agitation approach
Parent present
Avoid painful procedures until stabilized
Immediate actions and escalation
Time-critical actions
If impending respiratory failure, escalate to resuscitation bay
Airway team activation
Difficult airway equipment
If severe croup, nebulized epinephrine first-line temporizing therapy
Reassessment at 10-20 minutes
Systemic corticosteroid for all severities
Early administration
If oxygenation failure, supplemental oxygen by least-distressing method
Blow-by oxygen
Face mask if tolerated
Key concepts
Core bedside concepts
Viral upper airway inflammation with subglottic edema
Fixed narrowest pediatric airway segment
Symptoms peak at night and over first 1-3 days
Typical course 3-7 days
Barky cough and inspiratory stridor
Hoarseness
Nebulized epinephrine rapid onset and short duration
Observation required for recurrence after effect wanes
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.