ED Pathway for Evaluation/Treatment of
Children with Bronchiolitis
SUPPORTIVE CARE
Suction
Hydration, nutrition
Supplemental oxygen
Pulse oximetry
Fever Management
Additional Treatment Considerations
  • Albuterol Trial
  • Racemic epinephrine
  • Antibiotics
  • Hypertonic Saline
Further Diagnostic Testing
Consider ED Asthma Pathway if:
  • Recurrent wheezing / prior steroid use
  • Age > 12 months
  • Strong response to albuterol
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Mild
Moderate
Severe
Consider Suction-bulb
Suction
If wheezing:
Suction-wall
NPO
If wheezing: If severe respiratory distress:
    Consider:
    Racemic epinephrine
    HFNC and admit to PICU
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Discharge Criteria
Admission Criteria
  • Oxygen saturation > 90% awake
  • Adequate oral intake
  • Mild/moderate work of breathing
  • Reliable caretaker
  • Able to obtain follow-up care
  • MDI/spacer teaching if response to albuterol
  • Base decision on:
    • Repeated assessments
    • Response to therapy
    • Stage of illness
  • Admit if discharge criteria not met:
    • Inpatient: Requires 02 or progression expected
    • EDECU: Mild disease with expected LOS < 24 hours
    • ICU: Apnea, severe distress
              Requires HFNC / CPAP / intubation
  • Infants with these risk factors present early in the illness have higher risk of progression:
    • Oxygen saturation < 95%
    • Gestational age < 34 weeks
    • Respiratory rate ≥ 70
    • Age < 3 months
Posted: September 2005
Revised: September 2011, November 2013
Authors: J. Zorc, MD; K. Shaw, MD; L. Tyler, RT; B. Rodio, RN; S. Dooley, RN;