Emergent Management of Pediatric Bronchiolitis Treatment & Management

  • Author: Mark Louden, MD, FACEP; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Apr 22, 2011
 

Prehospital Care

Prehospital care consists of cardiorespiratory monitoring, positioning to facilitate respiratory efforts (ie, upright posture), administration of oxygen, and possibly a trial of bronchodilators.

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Emergency Department Care

General supportive measures are the mainstay of treatment for patients with bronchiolitis.

Patients should be made as comfortable as possible (held in a parent's arms or sitting in the position of comfort).

Cardiorespiratory monitoring is essential.

Pulse oximetry is a helpful tool, as hypoxia is common.

Humidified oxygen should be administered if the oxygen saturation is less than 94% on room air.

The ability to maintain adequate hydration should be assessed by observing patient oral intake. Many dyspneic infants have difficulty taking a bottle.

Fever and tachypnea increase insensible fluid losses.

Early effort should be made to isolate or cohort patients confirmed or likely to have RSV infection, especially from other patients at risk for severe disease.

Antibiotics are not indicated unless bacterial infection is suggested (eg, toxic appearance, hyperpyrexia, consolidation or focal lobar infiltrates on chest radiograph, leukocytosis, positive bacterial cultures).[2]

Concomitant otitis media is common and may be treated with oral antibiotics.

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Consultations

Early consultation with a pediatrician is advisable when the need for admission is anticipated. Intensive care consultation should be sought for patients who are severely ill.

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Contributor Information and Disclosures
Author

Mark Louden, MD, FACEP  Assistant Medical Director, Emergency Department, Duke Raleigh Hospital

Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Kirsten A Bechtel, MD  Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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