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Acute Bronchiolitis: Assessment and Management in Urgent Care
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Publication Date: January 2023 (Volume 2, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 01/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits, subject to your state and institutional requirements.

Editor-in-Chief

Keith A. Pochick, MD, FACEP
Attending Physician, Urgent Care, Charlotte, NC

Urgent Care Update Author

Amanda Nedved, MD
Urgent Care Physician; Associate Professor of Pediatrics, Children's Mercy Kansas City/University of Missouri–Kansas City School of Medicine, Kansas City, MO

Peer Reviewers

Danielle Federico, MD, FAAP
Medical Director, PM Pediatrics West Hartford; Regional Education Coordinator, Connecticut; West Hartford, CT

Charting & Coding Author

Brad Laymon, PA-C, CPC, CEMC
Certified Physician Assistant, Winston-Salem, NC

Abstract

Acute bronchiolitis is the most common lower respiratory tract infection in young children that leads to acute care visits and hospitalizations. Bronchiolitis is a clinical diagnosis, and diagnostic laboratory and radiographic tests play a limited role in most cases. Studies have demonstrated a lack of efficacy for bronchodilators and corticosteroids in most cases of bronchiolitis. Frequent evaluation of the patient’s clinical status, including respiratory rate, work of breathing, oxygen saturation, and the ability to take oral fluids, is 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 in the urgent care setting.

Case Presentations

CASE 1
A mother brings in her 9-month-old daughter, whom she describes as “gasping for air”...
  • The infant has had a runny nose and cough for a few days as well as a low-grade fever, but now she is breathing rapidly and wheezing, with lower intercostal retractions and nasal flaring.
  • The mother states that the infant has had wheezing in the past, and asks if the baby might have asthma since “it runs in the family.” She also indicates that in the last 12 hours, the baby has not taken her usual amount of fluids.
  • The infant's oxygen saturation level is 89% on room air.
  • You begin to think: Should I treat this as reactive airway disease, asthma, or bronchiolitis? Should I give the patient albuterol, nebulized epinephrine, or oxygen? Does this infant need steroids?
  • You also wonder whether this patient should be transferred to a higher level of care and if so, what mode of transport would be appropriate…
CASE 2
A 6-week-old boy presents with rhinorrhea and poor feeding for the last 2 days…
  • The mother states that he is not breastfeeding as well as usual due to his congestion. She says there is no family history of respiratory problems.
  • The boy was born prematurely at 33 weeks' gestation, requiring admission to the NICU for 2 weeks for respiratory support.
  • His oxygen saturation level is 91% to 92% on room air.
  • Should you give supplemental oxygen? Should you send respiratory viral panels? Does this infant need to be admitted to the hospital?

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