I knew I had gone out on a limb by suggesting that "most" [NOT all!!]
croupers who receive Epi merit longer periods of observation than the usual
2-4 hours. My point had more to do with the INDICATIONS for Epi. I see many
patients receiving Epi for mere presence of stridor. I really prefer
reserving it for the most severe patients with croup. This for 2 reasons.
One, it is very short acting. Secondly, it is not without side effects!
Tachyarrythmias are not unheard of.
Most kids with LTB have a benign course. The ones that truly need Epi are
severe enough wherein, I have to think twice before sending them home in a
I fully agree that Decadron, being the LONGER acting anti-inflammatory
option, facilitates early outpatient therapy.
For the moderately stridorous kids, I too tend to use a normal saline
updraft, give them steroids soon after arrival and then observe for a few
hours. If they are drinking, not hypoxemic and improved, I feel comfortable
sending them home.
I am still not sure how this concept of "rebound" worsening with epi was
Jay Pershad, M.D.
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