An 8-month-old girl is evaluated in the pediatric clinic in January due to increased work of breathing. She has had a runny nose, mild cough, and low-grade fever for the past three days. The patient was born full-term and is up to date on immunizations. Vital signs show a temperature of 37.6°C (99.7°F), a heart rate of 138/min, a respiratory rate of 56/min, and an oxygen saturation of 95% on room air. Physical examination demonstrates clear rhinorrhea, mild intercostal retractions, and bilateral expiratory wheezing with scattered crackles. The child is consolable and is feeding adequately. Which of the following is the most appropriate next step in management?
- Supportive care with nasal suctioning and hydrationAnswer
- BTrial of nebulized albuterol
- CEmpiric oral amoxicillin
- DOral dexamethasone administration
- EInhaled fluticasone therapy
Answer
Supportive care with nasal suctioning and hydration is the most appropriate intervention for this patient's mild acute viral bronchiolitis.
This patient presents with classic signs of acute viral bronchiolitis, characterized by a viral prodrome followed by lower respiratory tract signs such as wheezing and crackles. Because she is well-hydrated, maintaining a normal oxygen saturation, and exhibiting only mild retractions, her disease is considered mild. The most appropriate management is outpatient supportive care, which focuses on maintaining hydration and clearing the nasal passages with bulb suctioning to ease the work of breathing.
Step-by-Step Solution
Key Concept
The mainstay of treatment for mild acute viral bronchiolitis in infants is supportive care, avoiding the use of bronchodilators, systemic corticosteroids, or antibiotics.