Acute Bronchiolitis: Assessment and Management in the Emergency Department -

Acute Bronchiolitis: Assessment and Management in the Emergency Department
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Publication Date: October 2019 (Volume 16, Number 10)

No CME for this activity


Madeline M. Joseph, MD, FACEP, FAAP
Professor of Emergency Medicine and Pediatrics; Assistant Chair of Pediatric Emergency Medicine Quality Improvement, Department of Emergency Medicine, University of Florida College of Medicine- Jacksonville, Jacksonville, FL
Amy Edwards, DO
University of Florida at Jacksonville Pediatrics, Jacksonville, FL

Peer Reviewers

Michael J. Alfonzo, MD, MS
Assistant Professor of Emergency Medicine and Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, Komansky Children’s Hospital, New York, NY
Christopher Strother, MD
Associate Professor, Emergency Medicine, Pediatrics, and Medical Education; Director, Pediatric Emergency Medicine; Director, Simulation; Icahn School of Medicine at Mount Sinai, New York, NY


Acute bronchiolitis is the most common lower respiratory tract infection in young children that leads to emergency department visits and hospitalizations. Bronchiolitis is a clinical diagnosis, and diagnostic laboratory and radiographic tests play a limited role in most cases. While studies have demonstrated a lack of efficacy for bronchodilators and corticosteroids, more recent studies suggest a potential role for combination therapies and high-flow nasal cannula therapy. Frequent evaluation of patient clinical status including respiratory rate, work of breathing, oxygen saturation, and the ability to take oral fluids are important in determining safe disposition. This issue reviews the literature to provide evidence-based recommendations for effective evaluation and treatment of pediatric patients with acute bronchiolitis.

Excerpt From This Issue

As your shift is winding down at 4 AM, a mother brings in her 9-month-old infant, whom she describes as “gasping for air.” The baby has had a runny nose and cough for a few days as well as a low-grade fever, but now he is breathing rapidly and wheezing, with lower intercostal retractions. The mother states that the infant has had wheezing in the past, and she asks if he might have asthma since “it runs in the family.” She also indicates that in the last 12 hours, he has not taken his usual amount of fluids. His oxygen saturation level is 87% on room air. You begin to think… should I treat this as reactive airway disease, asthma, or bronchiolitis? When should I give the patient albuterol, nebulized epinephrine, or oxygen? Does the infant need steroids? You also wonder whether this patient is going to tire and require assisted ventilation or whether there are any other alternatives to intubation.

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