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Calculator - Westley Croup Severity Score - UpToDate
Calculator - Westley Croup Severity Score - UpToDate
Calculator - Westley Croup Severity Score - UpToDate
Level of consciousness
Normal, including sleep (0 points)
Disoriented (5 points)
Cyanosis
None (0 points)
With agitation (4 points)
At rest (5 points)
Stridor
None (0 points)
With agitation (1 point)
At rest (2 points)
Air entry
Normal (0 points)
Decreased (1 point)
Markedly decreased (2 points)
Retractions
None (0 points)
Mild (1 point)
Moderate (2 points)
Severe (3 points)
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8 to 11 Severe Frequent barky cough, stridor at rest, Single dose of oral/IM/IV dexamethasone 0.6 mg/kg
marked retractions, significant distress (maximum 10 mg)*
and agitation
Impending Depressed level of consciousness, Repeated doses of nebulized epinephrine** may be needed
12 to 17 respiratory stridor at rest, severe retractions, poor
failure air entry, cyanosis or pallor Intensive care unit admission is generally required
Notes
*The intravenous preparation of dexamethasone (4 mg per mL) can be given orally; mix with flavored syrup.
**Nebulized epinephrine has an onset of effect within 10 minutes. Nebulized racemic epinephrine is administered as
0.05 mL/kg per dose (maximum of 0.5 mL) of a 2.25% solution diluted to 3 mL total volume with normal saline.
Racemic epinephrine is commercially available in the United States and some other countries as a nebulizer
preparation (ie, single-use preservative-free bullets [ampules]). Nebulized L-epinephrine is administered as 0.5 mL/kg
per dose (maximum of 5 mL) of a 1 mg/mL (1:1000) preservative-free solution. L-epinephrine is the same type of
epinephrine used in other medical indications (eg, IM injection for anaphylaxis) and is widely available as a parenteral
preparation. Use of either product by nebulization is acceptable and may be determined by availability and institutional
protocol.
References
1. Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind
study. Am J Dis Child. 1978 May;132(5):484-7.
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