This protocol applies to children presenting with croup at severe severity, defined by a Westley croup score of 8 or more, in whom both inspiratory and expiratory stridor are present at rest — reflecting significant upper airway compromise requiring urgent structured management.
Stridor audible on both inspiration and expiration without provocation signals critical airway narrowing. This level of severity distinguishes the presentation from mild or moderate croup and determines the intensity of the clinical response required.
Immediate escalation to senior clinical colleagues is the first priority at this severity level. Keeping the child calm is an essential component of early management. The protocol then involves nebulised and corticosteroid-based treatment — the complete structured regimen, including agent selection, sequencing, and all further steps, is available via the full protocol.