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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Ronald S. -

Croup = SUB glottic edema, the narrowest part of the child airway. Doing a big needle through a erythematous, edematous way????
Has ANYONE out there done a needle cric on a kid with severe croup??
Will it not bleed like stink? Okay, when all else has failed, this may be the only option............................but may lead to more disaster?
Oh yes, IV epi for anaphylaxis in adults can lead to badness, like ventricular arrhythmias, been there, done that. In adults, very cautious, or use lower doses and escalate if needed.

David S. -

This is an interesting discussion, especially regarding use of heliox. However, I am concerned regarding your suggestion that needle cricothyrostomy would be an option for rescue in this situation-it's not. The reason is that the location of edema in croup is in precisely the area where a cricothyrostomy needle would be placed. Finding the tiny tracheal conduit and threading a cannula into it would almost certainly result in malposition at best and massive pneumomediastinum/PTX at worst. I think one would be best advised to pursue other methods of rescue, as you suggest-LMA, intubation with a small ETT, OR for tracheostomy/gas anesthesia induction etc.

Craig B., M.D. -

Re: PROPPR Trial - back when I was in school(the 70s) the surgeons said "if you are losing whole blood , you will get back whole blood." Are we not back to that for trauma and shock due to blood loss ?

Richard S. -

What about IM steroids (dexamethasone) if don't get 1st pass IV access?

paul b., MD -

Paul B M.D.
Guidelines from BC Child health {British Columbia} suggest nebulized budesonide as an alternative to dexamethasone citing equal efficacy. This strategy would avoid an IV poke agitating the child

James M., MD -

How can I look up a specific topic. For example. I'm pretty sure you all have discussed the overal utility on the BNP but I can't seem to find it anywhere. Thanks.

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