INSTRUCTIONS
(1) Stridor and Cyanosis Assessment: Strictly differentiate between symptoms occurring "at rest" versus only "with agitation." Symptoms at rest score significantly higher and indicate a compromised airway. (2) Level of Consciousness: Any disorientation, lethargy, or depressed mental status scores an immediate 5 points. This is a late, ominous sign of hypoxia and hypercapnia. (3) Air Entry: Listen laterally and at the lung bases. "Markedly decreased" air entry (a "quiet chest") in a tired-looking child is a sign of impending failure, not clinical improvement.
