I must say that most of our group uses 2-3 hours for observation for patients that have a
complete response to epi treatments (i.e. no resting stridor, no rtx/flaring, nl sats). We tend
to treat more aggressively for moderate stridor or increased WOB, decreased sats as even if these
don't result in severe croup scores the pt is uncomfortable, often not interested in po intake.
We have had no tachyarrythmias other than sinus tach which is benign and very few bounce backs of
pts who look asx at 2-3 hours post tx. As you point out it is short acting, so if they don't
worsen in a couple of hours I find it unlikely to occur later.
Virgil Davis, MD
Univ of Arizona.
Jay Pershad wrote:
> 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
> few hours.
> 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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