Moderate Croup (Westley Score 2–7) When Initial Treatment Has Not Achieved Improvement
Clinical Scenario
This protocol applies to a child presenting with moderate croup — Westley croup score 2–7, oxygen saturations above 94%, and mild recession — who has not responded adequately to the initial management step within the expected observation window.
Previous Treatment — Goals Not Met After 2–3 Hours
Initial management included keeping the child calm, corticosteroid therapy (oral or nebulised), and consideration of adrenaline nebulisation, with observation over 2–3 hours. Escalation to this protocol is triggered when the following targets have not been reached:
- No stridor at rest
- Normal oxygen saturations
- Good air entry
- Normal colour
- Normal level of consciousness
- Able to tolerate oral fluids
Next Step — Partial Overview
When the above goals have not been achieved, this protocol involves an escalated response requiring senior clinical involvement, alongside a structured approach to nebulised and corticosteroid treatment. The complete sequencing, decision points, and full management algorithm are in the protocol below.
References
- Moderate — Score 2 – 7
- Oxygen saturations > 94%
- Mild recession
- CALL FOR SENIOR HELP
- Keep child calm
- Adrenaline neb 0.4 mL/kg (max 5 mL) of 1:1000. This dose can be repeated after 30 minutes
- Oral dexamethasone 0.15mg/kg single dose, total 0.6mg/kg (max 16mg)
- Budesonide 2mg neb can be used, but oral dex is preferred.
- Minimum interval of 2 hours between oral doses of dexamethasone.
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