Bronchiolitis Clinical Pathway — Emergency Department
Bronchiolitis Clinical Pathway — Emergency Department
RT: Score-Treat-Score
Suction Trial (always suction prior to albuterol trial)
- Pulse oximetry
- Score patient's symptoms using the Response to Intervention Score on the Bronchiolitis flowsheet
- Treat - Suction nares
- Score the patient's symptoms following suctioning on the Bronchiolitis flowsheet
- If score does not improve, move on to Albuterol trial
Albuterol Trial
- Score patient's symptoms using the Response to Intervention Score on the Bronchiolitis flowsheet
- Treat - Albuterol trial X1 treatment with nebulizer
- Score the patient’s symptoms following the trial on the Bronchiolitis flowsheet
| Weight (kg) | Intermittent Nebulization (0.5% solution (5 mg/mL) |
MDI (90 mcg/puff) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| < 5 | 1.25 mg (0.25 mL) | Per physician's discretion | |||||||||
| ≥ 5 | 2.5 mg (0.5 mL) | 2-4 puffs | |||||||||
NOTE: Albuterol should NOT be continued if the patient does not respond to nebulized test dose.
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Use the Response to Intervention Score below to assess children after each intervention.
| 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 | |