Bronchiolitis algo v1

  • Clinical Status
    • No distress
      • Discharge Criteria
        • checks
          • Well appearing
          • Room air sat > 90%
          • Tolerating PO
          • No hx of cardio-pulmonary disease
          • Low risk for apnea
            • Full term: > 1 mo old
            • Premie: > 48 wks post conception
            • No witnessed apnea
        • Does not meet discharge criteria
          • Admit
        • Home Care
          • Nasal saline & bulb suction
          • Small volume, frequent feeds
          • Albuterol MDI with mask and spacer for repsonders
    • Poor PO, Sat < 90% up WOB
      • Suction
        • improved
          • Discharge criteria branch
        • worse
          • Severe distress > IV, 02, Monitor branch
        • no change
          • Consider trial of albuterol
            • improved
              • Discharge criteria branch
            • worse
              • Severe distress > IV, 02, Monitor branch
            • no change
              • Consider: Racemic epinephrine 3% saline neb
                • improved
                  • observation Re-eval for dispo
                • no change
                  • admit
    • Severe distress
      • IV, 02, Monitor
      • NS Bolus
      • Prepare to intubate
      • Consider:
        • checks
          • Albuterol
          • Racemic epi
          • 3% Saline neb
          • High flow nasal cannula
          • Bipap
          • Nitric Oxide
          • Heliox
        • Respiratory failure
          • Intubate

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