Inpatient Pathway for Treatment of
the Child with Bronchiolitis
the Child with Bronchiolitis
Additional Treatment Considerations
- Albuterol Trial
- Racemic epinephrine
- Antibiotics
- Hypertonic Saline
- Score-Treat-Score
Initial Work-up
- History and Physical
- Bronchodilators not recommended for typical bronchiolitis. If used, document reason and response.
- RT: Baseline Assessment
- Droplet/Contact Precautions
- Determine symptom severity
Severe
Moderate
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 - HFNC Weaning Recommendations: Bronchiolitis
- Q 2h assessments
- Nasal suctioning – Bulb/Wall
- Intermittent O2 monitoring
- IV fluids/NG tube feeds/PO
as tolerated
- Q 4h assessments
- Nasal suctioning – Bulb
- Intermittent O2 monitoring
- Resume normal feeds
ESCALATION
- Consider:
- Racemic epinephrine
- CAT Call
- Make child NPO
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
Revised: January 2016, February 2016, October 2017, March 2018, June 2018
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
Revised: January 2016, February 2016, October 2017, March 2018, June 2018
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