Moderate Stridor

Monitor oxygen saturation and provide supplemental oxygen if needed.

Keep the patient upright to reduce airway obstruction.

• Nebulized epinephrine (racemic or L-epinephrine)
  • Helps reduce airway swelling.
  • Indicated in cases of croup, anaphylaxis, or post-extubation stridor.
• Corticosteroids (e.g., dexamethasone, prednisone, budesonide nebulization)
  • Used for croup, airway inflammation, or post-extubation stridor.
  • Reduces airway swelling over hours.
• Heliox (Helium-Oxygen mixture)
  • Can improve airflow by reducing airway resistance in moderate cases.
• Antibiotics
  • If bacterial epiglottitis or tracheitis is suspected (e.g., ceftriaxone + vancomycin).
• Allergy Management (for anaphylaxis)
  • IM epinephrine, antihistamines, and steroids if stridor is due to allergic reaction.

3. Advanced Airway Management (If Worsening)

• If stridor progresses to severe airway obstruction, prepare for:
  • Intubation (preferably by an experienced provider).
  • Cricothyrotomy as a last resort in a “can't intubate, can't oxygenate” situation.

4. Identify & Treat the Underlying Cause

Croup → Nebulized epinephrine + steroids.

• Anaphylaxis → IM epinephrine, fluids, antihistamines.
• Epiglottitis → Avoid agitation, urgent airway management, IV antibiotics.
• Foreign body → Consider bronchoscopy if obstruction is suspected.
• Tracheomalacia/Tumor → May require bronchoscopy and ENT consultation.
• Trauma

 

 

 

 

 

1. ++++++++++++++++++++

   • Severe: Cyanosis, lethargy, marked retractions, impending respiratory failure
2. Ensure Airway and Oxygenation
   • Keep the child calm (agitation worsens airway obstruction).
   • Administer humidified oxygen (preferably in a non-threatening way like a blow-by method).
   • Avoid distressing procedures unless necessary (e.g., trying to visualize the throat).

 

References

1. https://www.drugs.com/dosage/dexamethasone.html#Usual_Pediatric_Dose_for_Croup