Question
Which of the following treatment modalities is NOT recommended for worsening respiratory distress in a child suspected to be suffering from acute croup?
| A. |
Sedation |
| B. |
Intravenous antibiotics |
| C. |
Nebulised racemic epinephrine |
| D. |
Intramuscular dexamethasone |
Show Answer
|
Correct Answer » A Explanation |
 |
Acute croup is a viral infection (most commonly parainfluenza virus) causing upper airway obstruction due to subglottic edema.
Typical features include barking cough, inspiratory stridor, and respiratory distress.
In worsening respiratory distress, airway patency and respiratory drive are critical.
Sedation is contraindicated in croup because:
- It depresses respiratory drive
- It reduces airway muscle tone
- It may precipitate sudden airway obstruction and respiratory failure
Thus, sedation can worsen an already compromised airway and is not recommended.
Explanation of Why Other Options Are Incorrect
Option B: Intravenous antibiotics
- Croup is usually viral, so antibiotics are not routinely required
- However, they may be used if bacterial superinfection (e.g., bacterial tracheitis) is suspected
- Hence, not contraindicated
Option C: Nebulised racemic epinephrine
- Causes vasoconstriction → reduces airway edema
- Provides rapid symptomatic relief
- Standard treatment in moderate to severe croup
Option D: Intramuscular dexamethasone
- Corticosteroids reduce airway inflammation
- Improve symptoms and reduce hospital admission
- Standard of care