Question

A 7-month-old boy is brought to the emergency department in mid-January with a 3-day history of worsening respiratory distress. He was born at 39 weeks gestation and has no significant past medical history. The illness began with rhinorrhea, low-grade fever, and a mild cough. The patient's mother has a history of severe persistent asthma and wonders if he needs her 'breathing treatments.'

Upon arrival, vital signs show:
* Temperature: $38.3^\circ\text{C}$ ($100.9^\circ\text{F}$)
* Heart rate: $182/\text{min}$
* Respiratory rate: $74/\text{min}$
* Oxygen saturation: $86\%$ on room air

Physical examination reveals an anxious, tachypneic infant with marked head bobbing, severe subcostal retractions, and nasal flaring. Lung auscultation demonstrates diffuse polyphonic wheezing, a markedly prolonged expiratory phase, and scattered bibasilar crackles.

Laboratory and radiographic findings:
* Leukocyte count: $11,800/\text{mm}^3$ ($68\%$ lymphocytes, $25\%$ neutrophils)
* Capillary blood gas (room air): $\text{pH} = 7.30$, $\text{pCO}_2 = 60\text{ mm Hg}$
* Chest radiograph: Bilateral pulmonary hyperinflation, flattened hemidiaphragms, and extensive peribronchial thickening without distinct lobar consolidation.

Which of the following interventions MUST be included in the evidence-based acute management bundle for this patient? (Select exactly 2 interventions)