Summary

The Westley croup score (0–17) grades severity using stridor, retractions, air entry, cyanosis, and level of consciousness [1]. Dexamethasone 0.6 mg/kg (max 10 mg) is given at every severity level, with nebulized epinephrine added at moderate to severe scores.
Croup intubation is rare, occurring in under 1% of cases.
The HASS asthma score grades severity using respiratory rate, work of breathing, ability to speak, wheeze pattern, and SpO₂ [2]. Treatment escalates from an inhaler and oral steroids (mild) to continuous albuterol, terbutaline, and IV steroids (severe).
A PaO₂ below 50 or a PaCO₂ above 50 in an asthma exacerbation defines respiratory failure and mandates ICU admission.
The Broselow tape estimates weight from measured length when an actual weight is unavailable, and cross-references weight-based resuscitation drug doses. Confirm the tape edition in use at your institution, since color-to-weight ranges have changed across editions.

Westley Croup Score

Component	0	1	2	3
Stridor	None	With agitation	At rest
Retractions	None	Mild	Moderate	Severe
Air entry	Normal	Decreased	Markedly decreased
Cyanosis	None	With agitation	At rest
Level of consciousness	Normal	Altered/disoriented

Maximum score is 17. The score was derived and validated alongside nebulized racemic epinephrine treatment for croup [1].

Open the Westley Croup Score Calculator →

Management by score

Score	Severity	Findings	Treatment
≤2	Mild	Stridor only with agitation, minimal or no retractions	Dexamethasone 0.6 mg/kg PO (max 10 mg). Send home. Improvement expected in 24–48 hours.
3–7	Moderate	Stridor at rest, breathing adequate	Dexamethasone 0.6 mg/kg PO (max 10 mg) plus nebulized epinephrine if stridor persists. Admission depends on response and ability to observe for rebound.
8–15	Severe	Marked stridor at rest, marked retractions, or cyanosis	Dexamethasone 0.6 mg/kg IV/IM (max 10 mg) plus nebulized epinephrine, may repeat every 15–20 minutes. Admit.

Nebulized epinephrine dosing:

Racemic epinephrine: 0.5 mL of 2.25% solution in 3 mL normal saline.
L-epinephrine: 0.5 mL/kg of 1:1000 (max 5 mL), nebulized. L-epinephrine is equally effective to racemic epinephrine and is more widely available [1].

Onset of nebulized epinephrine is within 10–30 minutes, with effects lasting approximately 2 hours.

Caution. Observe for at least 2–4 hours after nebulized epinephrine for rebound symptoms before considering discharge.

Clinical pearl. A child with stridor only when upset and no retractions scores ≤2 (mild). A child with stridor at rest, marked retractions, and altered consciousness scores in the severe range (8–15) and warrants admission with epinephrine on board.

HASS Asthma Score

Component	Mild	Moderate	Severe
Respiratory rate	<30	31–40	>40
Work of breathing	No retractions	Retractions, no flaring	Retractions with flaring
Speech	Full sentences	Short phrases	Cannot speak
Wheeze	End-expiratory only	Throughout expiration	Silent chest, no air movement (ominous)
SpO₂ (room air)	>95%	90–95%	<90%

Grading acute asthma severity by clinical signs across respiratory effort, aeration, and oxygenation is a validated approach to scoring exacerbation severity [2].

Open the HASS Asthma Calculator →

Caution. A silent chest with no air movement is a severe finding, not a reassuring one. It reflects minimal airflow, not resolution of bronchospasm.

Management by severity

Severity	Treatment	Disposition
Mild	Albuterol inhaler, 2 puffs every 4–6 hours. Prednisone 0.5–1 mg/kg (max 50 mg) or dexamethasone 0.6 mg/kg (max 10 mg) for 3–5 days.	Home
Moderate	Albuterol 0.15 mg/kg nebulized every 1–2 hours plus ipratropium 250 mcg. Steroids (IV or oral).	Many improve in the ED; some require admission.
Severe	Continuous albuterol (10–15 mg/hour) plus terbutaline 0.01 mg/kg (max 0.25 mg) subcutaneously every 15–30 minutes, or IV epinephrine 1:10,000 if not responding. IV methylprednisolone 1–2 mg/kg every 6 hours or IM/IV dexamethasone 0.6 mg/kg.	Admit. PaO₂ <50 or PaCO₂ >50 requires ICU.

Broselow Tape

The Broselow tape is laid alongside the supine child. The color zone matching the child's length gives a weight range and a corresponding card of weight-based drug doses.

Color-to-weight ranges vary by edition. Always verify your institution's current edition.

Color	Weight range
Grey	6–7 kg
Pink	8–9 kg
Red	10–11 kg
Purple	12–14 kg
Yellow	15–18 kg
White	19–23 kg
Blue	24–29 kg
Orange	30–36 kg

Emergency drugs pre-loaded by weight

Drug	Dose
Epinephrine (1:10,000)	0.01 mg/kg IV/IO
Atropine	0.02 mg/kg (min 0.1 mg, max 0.5 mg)
Amiodarone	5 mg/kg IV/IO bolus, may repeat 5 mg/kg (up to 2 additional doses)
Naloxone	0.1 mg/kg (max 2 mg)
Calcium gluconate	0.6 mL/kg of 10%
Dextrose	0.5 g/kg (2 mL/kg of 25%)
Sodium bicarbonate	1 mEq/kg

Interpretation

Westley croup: score 0–17, then dose dexamethasone at every level and add epinephrine plus admission at mo

References

Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup. Am J Dis Child. 1978;132(5):484-487. doi:10.1001/archpedi.1978.02120300044008
Ducharme FM, Chalut D, Plotnick L, et al. The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity. J Pediatr. 2008;152(4):476-480. doi:10.1016/j.jpeds.2007.08.034

Scoring Respiratory Illness in Children: Westley Croup Score and HASS Asthma Assessment