Bronchiolitis

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SeverityChoose oneFirst line

Work of breathing presentChoose any

Work of breathing absentChoose any

Oxygen saturationChoose one

FeedingChoose one

ApneaChoose one

Risk factors for severe diseaseChoose any

TestingChoose one

Chest x-rayChoose one

Suctioning in clinicChoose one

Albuterol trialChoose one

PlanChoose one

Smoke exposureChoose one

PreventionChoose any

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling

Bronchiolitis usually worsens over days 3-5 before improving, and cough can last a few weeks.

Supportive careChoose anyParagraph

Counseling

Suction before feeds and sleep. Return precautions given including fast or labored breathing, pauses in breathing, color change, fewer wet diapers, poor feeding, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Bronchiolitis
• No retractions, nasal flaring, head bobbing, or grunting
• Oxygen saturation 95% or higher on room air
• Feeding well with good urine output
• No apnea or cyanosis
• Risk factors for severe disease: none
• Viral testing and chest x-ray not needed for typical bronchiolitis
• Home with close follow-up and return precautions
• No tobacco smoke exposure at home
• Follow up as needed for worsening or concerns

Bronchiolitis usually worsens over days 3-5 before improving, and cough can last a few weeks. Recommended supportive care with OTC medications as needed with an emphasis on hydration and frequent nasal suctioning. Suction before feeds and sleep. Return precautions given including fast or labored breathing, pauses in breathing, color change, fewer wet diapers, poor feeding, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Diagnosis and severity by history and exam
Moderate work of breathing but safe for home
No risk factors for severe disease
Age < 12 weeks; prematurity; heart or lung disease; immunodeficiency
No routine labs or imaging
RSV positive; viral testing sent
No albuterol, epinephrine, steroids, hypertonic saline (ED), chest PT
No antibiotics unless concurrent bacterial infection
Send to ED or admit for work of breathing, hypoxemia, apnea, or poor hydration
Nasal suctioning (not deep)

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Smaller more frequent feeds; suction before feeds
Course: worse days 3–5, symptoms 2–3 weeks
Return precautions: work of breathing, apnea, color change, fewer wet diapers, poor feeding
Ask about tobacco smoke
Counsel on smoke exposure and cessation
Encourage breastfeeding
Hand hygiene; household transmission
RSV antibody after recovery if eligible and not yet given

Return precautions in the template

fast or labored breathingpauses in breathingcolor changefewer wet diaperspoor feeding

Bronchiolitis

What the sources cover

Return precautions in the template

Sources