What about those long, "barky" nights?
DOI:
https://doi.org/10.29173/cjen328Abstract
This article was submitted by Janielee Williamson, RN, Cochrane, Alberta. Janie is the project coordinator for a multi-centre research project across Alberta looking at the best method for disseminating practice guidelines to physicians. The project personnel are working in collaboration with the Alberta Medical Association CPG Committee to determine which method improves the delivery of best practice for children with croup, while ensuring optimum care for the child and determining which method has the best overall benefit for the health care system and the family. All emergency department personnel are familiar with this scenario: 18-month-old boy presents to the emergency department at 2 a.m. on December 18. Parents look worried, yet they are baffled. As they tell their story, they are almost apologetic, “Really, he was much worse at home, he seems so much better since we drove to the hospital. He woke up in distress, he couldn’t breathe and he was making this awful noise when he took a breath in. And his cough – I’ve never heard anything like it – he sounded like a dog... or no, more like a seal. Really, it was terrible!” There, in mom’s arms, is a happy, quiet boy looking around. When you try to examine him, his cry is stridorous and you hear the bark... reassuringly you smile back at the mom. “Yes, we know, and no we don’t have magic doors. HE HAS CROUP.”References
Andrade, M.A. Hoberman, A., Glustein, J., Paradise, J.L. & Wald, E.R. (1998). Acute otitis media in children with bronchiolitis. Pediatrics, 101(4), 617-9.
Ausejo, M., Saenz, A., Pham, B., Kellner, J.D., Johnson, D.W., Moher, D., et al. (1999). The effectiveness of glucocorticoids in treating croup: meta-analysis. BMJ, 319(7210), 595-600.
Bjornson, C., Klassen, T.P., Williamson, J., Brant, R., Plint, A., Bulloch, B., et al. (in press). The use of dexamethasone in mild croup: A multi-center randomized controlled trial. Pediatr Research.
Chin, R., Browne, G.J., Lam, L.T., McCaskill, M.E., Fasher, B., & Hort, J. (2002). Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department. J Paediatr Child Health, 38(4), 382-7.
Corneli, H.M., & Bolte, R.G. (1992). Outpatient use of racemic epinephrine in croup. American Family Physician, 46(3), 683-4.
Denny, F.W., Murphy, R.F., Clyde, W.A. Jr., Collier, A.M., & Henderson, F.W. (1983). Croup: An 11-year study in a pediatric practice. J Pediatr, 71(6), 871-876.
Donnelly, B., McMillan, J., & Weiner, L. (1990). Bacterial tracheitis: Report of eight new cases and review. Rev Infect Dis, 12, 729-35.
Duggan, D.E., Yeh, K.C., Matalia, N., Ditzler, C.A., & McMahon, F.G. (1975). Bioavailability of oral dexamethasone. Clin Pharmacol Ther, 18(2), 205-9.
Edwards, K.M., Dundon, C., & Altemeier, W.A. (1983). Bacterial tracheitis as a complication of viral croup. Pediatr Infect Dis J, 2, 390-1.
Fanconi, S., Burger, R., Maurer, H., Uehlinger, J., Ghelfi, D., & Muhlemann, C. (1990). Transcutaneous carbon dioxide pressure for monitoring patients with severe croup. J Pediatr, 117(5), 701-5.
Geelhoed, G., & Macdonald, W.B.G. (1995). Oral and inhaled steroids in croup: A randomized, placebo controlled trial. Pediatr Pulmonol, 20, 355-361.
Geelhoed, G.C., Turner, J., & Macdonald, W.B.G. (1996). Efficacy of a small single dose of oral dexamethasone for outpatient croup: A double blind placebo controlled clinical trial. BMJ, 313, 140-142.
Heikkinen, T., Thint, M., & Chonmaitree, T. (1999). Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Eng J Med, 340(4), 260-4.
Johnson, D.W., & Williamson, J. (2001). Croup: Duration of symptoms and impact on family functioning. Pediatr Research, 49, 83A.
Johnson, D., Schuh, S., Koren, G., & Jaffee, D.M. (1996, April). Outpatient treatment of croup with nebulized dexamethasone. Arch Pediatr Adolesc Med, 150(4), 349-55.
Johnson, D.W., Jacobson, S., Edney, P.C., Hadfield, P., Mundy, M.E., & Schuh, S. (1998). A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo in moderately severe croup. N Eng J Med, 339(8), 498-503.
Kelley, P.B., & Simon, J.E., (1992). Racemic epinephrine use in croup and disposition. Am J Emerg Med., 10(3), 181-3.
Klassen, T.P., Craig, W.R., Moher, D., Osmond, M.H., Pasterkamp, H., Sutcliffe, T., et al. (1998). Nebulized budesonide and oral dexamethasone for treatment of croup: A randomized controlled trial. JAMA, 279(20), 1629-32.
Kunkel, N.C., & Baker, B.M. (1996). Use of racemic epinephrine, dexamethasone, and mist in the outpatient management of croup. Pediatr Emerg Care, 12(3), 156-9.
Lavine, E., & Scolnik, D. (2001). Lack of efficacy of humidification in the treatment of croup: Why do physicians persist in using an unproven modality? Can J Emerg Med, 1, 209-12.
Ledwith, C.A., Shea, L.M., & Mauro, R.D. (1995). Safety and efficacy of nebulized racemic epinephrine in conjunction with oral dexamethasone and mist in the outpatient treatment of croup. Ann Emerg Med, 25, 331-7.
Luria, J.W., Gonazlez-del-Rey, J.A., DiGiulio, G.A., McAneney, C.M., Olson, J.J., & Ruddy, R.M. (2001). Effectiveness of oral or nebulized dexamethasone for
children with mild croup. Arch Pediatr Adolesc Med, 155(12), 1340-5.
Margolis, P.A., Ferkol, T.W., Marsocci, S., Super, D.M., Keyes, L.L., McNutt, R., et al. (1994). Accuracy of the clinical examination in detecting hypoxemia in infants with respiratory illness. J Pediatr, 124(4), 552-560.
Neto, G., Kentab, O., Klassen, T.P., & Osmond, M.H. (2002). A randomized controlled trial of mist in the acute treatment of moderate croup. Acad Emerg Med, 9(9), 873-9.
Newth, C.J., Levison, H., & Bryan, A.C. (1972). The respiratory status of children with croup. J Pediatr, 81(6), 1068-73.
Orenstein, D.M. (2000). Acute inflammatory upper airway obstruction. In R.E. Behrman, R.M. Kleigman, & H.B. Jenson (Eds.), Nelson textbook of Pediatrics (pp. 1274-9). Philadelphia: W.B. Saunders Company.
Patel, H., Macarthur, C., & Johnson, D. (1996). Recent corticosteroid use and the risk of complicated varicella in otherwise immunocompetent children. Arch Pediatr Adolesc Med, 150, 409-14.
Rapkin, R.H. (1972). The diagnosis of epiglottitis: Simplicity and reliability of radiographs of the neck in the differential diagnosis of the croup syndrome. J Pediatr, 80(1), 96-8.
Rizos, J.D., DiGravio, B.E., Sehl, M.J., & Tallon, J.M. (1998). The disposition of children with croup treated with racemic epinephrine and dexamethasone in the emergency department. J Emerg Med, 16(4), 535-9.
Sofer, S., Dagan, R., & Tal, A. (1991). The need for intubation serious upper respiratory infection in pediatric patients (a retrospective study). Infection, 19, 131-4.
Super, D.M., Cartelli, N.A., Brooks, L.J., Lembo, R.M., & Kumar, M.L. (1989). A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis. J Pediatr, 115(2), 323-9.
Tan, A.K., & Manoukian, J. (1992). Hospitalized croup (bacterial and viral): The role of rigid endoscopy. J Otolaryngol, 21(1), 48-53.
Tong, M.C., Chu, M.C., Leighton, S.E., & van Hasselt, C.A. (1996). Adult croup. Chest, 109(6), 1659-62.
Wagener, J.S., Landau, L.I., Olinsky, A., & Phelan, P.D. (1986). Management of children hospitalized for laryngotracheobronchitis. Pediatr Pulmonol, 2(3), 159-62.
Waisman, Y., Klein, B.L., Boenning, D.A., Young, G.M., Chamberlain, J.M., O’Donnell, R., et al. (1992). Prospective randomized doubleblind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup). Pediatrics, 89(2), 302- 6.
Westley, C.R., Cotton, E.K., & Brooks, J.G. (1978). Nebulized racemic epinephrine by IPPB for the treatment of croup. Am J Dis Child, 132(5), 484-487.
Downloads
Published
How to Cite
Issue
Section
License
The Canadian Journal of Emergency Nursing is published Open Access under a Creative Commons CC-BY 4.0 license. Authors retain full copyright.