Review Question - QID 103336

This patient has bronchiolitis. Bronchiolitis is best treated with supportive measures, which include nasal suctioning, oxygen therapy, and possibly hospitalization.

Bronchiolitis is defined as an infection of the lower airways. Although most cases require only supportive care (nasotracheal suctioning, oxygen, fluid resuscitation), patients who are less than two months old, hypoxemic, or severely dehydrated are likely to be admitted. Treatment should be initiated promptly upon presentation to the hospital or clinic.

Dawson et al. review the management of respiratory syncytial virus (RSV) in infants. RSV is the most common cause of bronchiolitis. Patients typically present with cough, rhinorrhea and wheezing. There is also an increased risk of apnea. Workup does not require any specific laboratory or radiographic testing. Most cases recover completely with supportive treatment. If the patient is high-risk (premature, congenital heart disease, chronic lung disease) then palivizumab may be indicated. Frequent hand washing is always encouraged as the virus spreads easily.

Ralston et al. discuss the most up-to-date recommendations for the treatment of bronchiolitis. Beyond supportive care, clinicians should not administer albuterol, epinephrine, steroids, or antibiotics. Nebulized hypertonic saline is appropriate if the patient is hospitalized. Patients should be given oxygen if saturation is below 90%. Above 90% saturation, oxygen is optional. If the patient has difficulty maintaining hydration, nasogastric (NG) or IV fluids should be administered.

Incorrect answers:
Answer 1: This would be an appropriate treatment for viral croup.
Answer 2: These medications would be an appropriate combination to treat an asthma exacerbation.
Answer 3: This management may be used for epiglottitis.
Answer 4: This treatment regimen would be appropriate for bacterial tracheitis.