An -month-old boy is brought to the emergency department in late January by his parents due to severe difficulty breathing. His parents report a -day history of clear nasal discharge, a mild cough, and a low-grade fever. Over the past hours, his breathing has become increasingly rapid and labored, and he has been feeding poorly. He was born at full term and has no prior history of wheezing or atopic dermatitis. His -year-old sister recently recovered from a mild 'cold'.
Vital signs are:
- Temperature: ()
- Heart rate:
- Respiratory rate:
- Oxygen saturation: on room air
Physical examination reveals an irritable infant with significant nasal flaring and marked subcostal and intercostal retractions. Lung auscultation demonstrates a prolonged expiratory phase with diffuse bilateral wheezing and scattered coarse crackles. A rapid viral panel is positive for respiratory syncytial virus (RSV).
Which of the following interventions are appropriate components of the immediate management bundle for this patient? (Select all that apply)
- Initiation of heated, humidified supplemental oxygenAnswer
- Routine nasopharyngeal suctioning of secretionsAnswer
- CAdministration of a trial of nebulized albuterol
- DAdministration of systemic dexamethasone
- EInitiation of empiric intravenous ceftriaxone and azithromycin