Inpatient Pathway for Treatment of the Child with Bronchiolitis
Related Pathway:
ED Bronchiolitis
Pathway
SUPPORTIVE CARE
Suction
Hydration, nutrition
Supplemental oxygen
Pulse oximetry
Fever Management
Additional Treatment Considerations
  • Albuterol Trial
  • Racemic epinephrine
  • Antibiotics
  • Hypertonic Saline
  • Score-Treat-Score
Further Diagnostic Testing
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Initial Work-up
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Severe
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Moderate
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Mild
  • Q 1h assessments
  • Nasal suctioning - Wall
  • Continuous O2 monitoring
  • CR Monitoring
  • IV fluids/NG tube feeds/PO
    as tolerated
  • Use of HFNC automatically
    classifies patient as Severe
  • Q 2h assessments
  • Nasal suctioning – Bulb/Wall
  • Intermittent O2 monitoring
  • IV fluids/NG tube feeds/PO
    as tolerated
  • Q 4 h assessments
  • Nasal suctioning – Bulb
  • Intermittent O2 monitoring
  • Resume normal feeds
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ESCALATION

Response to Intervention Score

    Mild (0) Moderate (1) Severe (2)
RR < 3 months 30-60 61-80 > 80
3 - < 12 months 25-50 51-70 > 70
1y – 2y 20-40 41-60 >60
WOB None or mild Intercostal retractions Nasal flaring, grunting, head bobbing
Mental Status Baseline Fussy or anxious Lethargic or inconsolable
Posted: November 2013
Authors: M. Dunn, MD; J. Zorc, MD; J. Kreindler, MD; L. Tyler, RRT; E. Pete Devon, MD; M. McCloskey,
RN; V. Madrigal, MD; L. McAndrew, MD; A. Barnes, MD; A. Gahman, RN; K. Leach, RN, R. Keren, MD