Your patient is a 10-month-old girl who has a clinical presentation of acute bronchiolitis and no risk factors for severe bronchiolitis or apnea. She has been ill for three days. The baby’s parents are anxious about her wheezing, although this is the first episode. Her SpO2 level is 97%. The mother says the baby has been breastfeeding, although for somewhat shorter periods than usual, and has had little interest in solid foods since becoming ill. What is the best next step in the management of this patient?
A. Administer nebulized hypertonic saline.
B. Administer nebulized albuterol.
C. Prescribe a tapered course of corticosteroids.
D. Send her home with instructions to the parents to monitor her hydration status, give appropriate dosing of over-the-counter antipyretics as needed, and perform nasal suctioning, along with providing education on the signs and symptoms that would prompt a return to care
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Answer: D. Most children who present to urgent care with bronchiolitis will have a mild disease course and can be discharged home with appropriate education on supportive care and a contingency plan for what to do if symptoms do not improve or worsen. Although the disease course is variable and some patients with bronchiolitis will have a severe course, this patient does not have history or physical examination findings that would prompt ED transfer or hospitalization at this point.
Last Updated on January 26, 2023