Croup

We can hear it from the sidewalk as soon as we step out of the ambulance. A cough as distinct as it is terrifying, the "bark, bark, bark" of a child with croup. We haul the stretcher through the ice and snow that is thickly coating the driveway, squeezing past a minivan to get to the front door.

"Bark, bark, bark". An adorable little boy, about 5 years old, is being held by his worried mother on the couch. There are many firefighters and even a police officer in the room, but I ignore them all as I focus on my little patient. He is pale, with a bluish tinge around his mouth and nose; wide terrified eyes stare up at me, but never really focus. He is fighting for breathe through his narrowed airway, all of his accessory muscles have been recruited to help him draw air in. He is the worst I've seen yet, he is rapidly reaching exhaustion and will stop breathing sooner rather than later as his airway continues to swell shut.

My partner is assessing his vital signs as I talk to the parents and get a history, all the while pulling out the medication he needs to open up his throat. Remembering my last croup call where my partner knocked over my mask with 4/5ths of the medication already drawn up, I recruit the firefighter with the steadiest hands to hold it for me. The one without kids of his own, most likely. I now must crack open 5 glass vials and using a syringe, draw out each 1mL amount of epinephrine. I must be as fast as possible, as this child is losing the battle, his eyes beginning to roll back before he fights his way back to consciousness. He's a tough little guy.

We get the mask on his face and carry him right outside. No waiting around for the meds to work, I don't want to have to ventilate this kid if and when he stops breathing. Then, about 2 minutes after the mask goes on, the magic happens. His cough lessons, his breathing eases, and he begins to cry and squirm like a scared 5 y/o should. "Mommy, I don't want to go! I'll be good, don't make me go to the hospital!". His Mom has tears of relief in her eyes as she reassures her little boy, and thanks me repeatedly. I am so happy I have the ability to treat this illness, I never get tired of seeing the rapid turn-around in these kids. He is breathing much more calmly now, and his Mom and I keep watch as he starts to fall asleep, exhausted by his previous effort to breathe, bathed in the glow of our strobe lights.