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Wednesday, April 1, 2020

MDM - Croup


[##-month/year-old male/female] with history and exam consistent with likely croup.

Initial consideration in this patient included croup, pneumonia, allergic reaction, bacterial tracheitis, pharyngitis, pneumonia, bronchitis, epiglottitis, retropharyngeal abscess (RPA), peritonsillar abscess (PTA), diphtheria, foreign body obstruction, and esophageal pathology among others. 

Patient presented with [mother/father/parents] with report of [dry/barking] cough consistent with croup in patient within the expected age (3 months to approximately 5 years old).  Patient [with/without measured/reported] fever and associated [upper respiratory symptoms].  Patient noted to have a Westley Croup Score of [0-17] consistent with [mild/moderate/severe] illness.  Doubt pneumonia given absence of productive cough or abnormal lung sounds.  Chest x-ray [felt to not be indicated at this time/obtained and noted to be unremarkable].  No evidence of acute otitis media noted on exam.  No evidence of significant pharyngeal erythema, exudate, or other findings suggestive of significant pharyngitis on ED evaluation. 

Doubt bacterial tracheitis in otherwise well-appearing child without findings suggestive of purulent sputum, respiratory distress, or other suggestive findings.  Improvement noted with treatment with [Decadron/racemic epinephrine/Acetaminophen/Ibuprofen] in the ED prior to discharge.  Patient noted to be tolerating fluids by mouth prior to discharge with no evidence of stridor, cyanosis or respiratory distress at time of discharge.

Prior to discharge, we discussed return precautions, specifically for evidence of worsening infection or bacterial tracheitis, treatment [with Decadron/Acetaminophen/Ibuprofen], and follow up with primary care doctor within [2-3 days/1 week] for further evaluation, and the patient's [mother/father/parents] demonstrated understanding and agreement.


https://www.mdcalc.com/westley-croup-score

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