Croup: Repeating Racemic Epi in the ED

[suckstobeme]

So you get a 12m old in mild to mod respiratory distress, croupy cough, stridor.
You give 'em Racemic Epi and Decadron. They get better, respirations and stridor resolved.
You watch 'em for an hr. Stridor returns but no respiratory distress. Other than stridor, looks pretty good.

What do you do?

A) Admit- once you get rebound stridor, automatic admit period
B) Repeat racemic epi neb and give them another chance
C) Depends
D) Something else

Also, how long do you guys observe your racemic epis?

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[RustedFox]

E) Do a forum search.

I kid. I kid. - but really, pinipig had this same question not long ago and the discussion that was generated was really good.

 

[Stitch]

Here's the thread mentioned. Good stuff in there.

My practice has been to observe for 3 hours post racemic epi. If there is stridor at rest (patient is asleep or at least calm) within that time period, admit for further treatments or observation.