Original Publication
Open Access

Simulation Case: Croup

Published: July 30, 2015 | 10.15766/mep_2374-8265.10141

Included in this publication:

  • Instructor's Guide.docx
  • Croup Simulation Stats and Supplements.pptx
  • Appendix.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


This simulation case provides a reference guide for the instruction of the acute and emergent management of pediatric respiratory distress caused by croup. This guide is intended for clinicians teaching emergency medicine and acute care to medical students and residents of all specialties involved in the management of pediatric patients. This guide includes a simulation script, visual props, and tips on how to effectively use a high-fidelity mannequin to assist the teacher to effectively administer the simulation. This guide also includes a novel evaluation tool, the STAT tool, that outlines specific learner goals and provides the teacher with an effective tool to administer real-time evaluation and immediate feedback to the learner. This scenario was presented and instructed during a simulation scenario as part of the Emergency Medicine didactic curriculum. Learners included first- to third-year Emergency Medicine residents, residents from other services rotating in Emergency Medicine at that time to include internal medicine residents, and medical students. This case was sufficiently difficult that most second-year residents scored most of the critical actions, but still had performance deficits that allowed for a productive debriefing. Deficits were primarily centered around differentiating lower vs. upper airway etiologies and administering the appropriate medication.

Educational Objectives

By the end of this module, the learner will be able to:

  1. Recognize and stabilize pediatric respiratory distress in a pediatric emergency department patient.
  2. Recognize progression to respiratory failure and need for intubation.
  3. Diagnose and manage severe croup.
  4. Differentiate upper airway vs. lower airway respiratory pathology.
  5. Exhibit proficiency in selecting appropriate pediatric airway adjuncts.

Author Information

  • Leo Damasco, MD: Madigan Army Medical Center
  • Jay Baker, MD: Madigan Army Medical Center

None to report.

None to report.


  1. Cherry, J. Clinical practice: croup. N Engl J Med. 2008 Jan;358:384-9 http://dx.doi.org/10.1056/NEJMcp072022
  2. Rudolph JW, Simon R, Raemer DB, Eppich WJ. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med. 2008 Nov;15(11):1010-6. http://dx.doi.org/10.1111/j.1553-2712.2008.00248.x
  3. Woods, CR. Croup: clinical features, evaluation, and diagnosis. UpToDate [Internet]. 2013 [updated 2015 Feb 18]. Available from: http://www.uptodate.com/contents/croup-clinical-features-evaluation-and-diagnosis?source=search_result&search=woods+croup+clinical+features&selectedTitle=2%7E63
  4. Zoorob, R, Sidani, M., Murray J. Croup: an overview. Am Fam Physician. 2011 May 1;83(9):1067-73.


Damasco L, Baker J. Simulation case: croup. MedEdPORTAL. 2015;11:10141. https://doi.org/10.15766/mep_2374-8265.10141