Board Review: Acute Signs and Symptoms
An 8-month-old male born at 36 wks without any complications with no medical problems who presents with wheezing, increased work of breathing, rhinorrhea and cough for the past 2 days. On exam, he has a low grade temperature, wheezing in all lung fields, subcostal retractions and nasal flaring. HR is 156 bpm, RR 70, Oxygen saturation is 90% on room air. Mother says other siblings in the house have had a cold the past few days. What is the next step in the management of this patient?
a. Administer IV dexamethasone
b. Administer broad spectrum IV antibiotics
c. Admit with supportive measures
d. Administer inhaled corticosteroids
Answer: C. This patient is presenting with acute signs and symptoms of bronchiolitis which include rhinorrhea, cough, wheezes, cough, crackles, use of accessory muscles, and nasal flaring. Babies born prematurely are at increased risk for severe bronchiolitis. Clinically, bronchiolitis occurs primarily <2 years of age, with a peak presentation between 6 and 12 months.
Treatment for bronchiolitis includes supportive care measures: nasal suctioning and saline drops, oxygen, isotonic fluids, and ventilatory support if needed. Consider hospitalization if persistent increased work of breathing, inability to maintain hydration/feeding, or hypoxia. Beta agonists can be trialed if the patient has a family history suggestive of asthma or atopy. Corticosteroids are not recommended for routine use.
Bjoernsen, L. P., & Ebinger, A. (2016). Chapter 124 Wheezing in Infants and Children In Tintialli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York, NY: McGraw-Hill Education.
Cade A, Brownlee KG, Conway SP, et al. Randomised placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis. Arch Dis Child 2000; 82:126.